National Alliance on Mental Illness
HHS Public Stakeholder Listening Session
Parity for Mental Health and Substance Use Disorder Coverage
Date: July 27, 2017
Location: Hubert H. Humphrey Building, First Floor Auditorium
200 Independence Avenue SW.
Washington, DC 20201
Contact: Laurel Fuller
Telephone: (202) 690–5949
Name: Sita Diehl, MA, MSSW
Title: Director of Policy and State Outreach
Position: National Alliance on Mental Illness, NAMI
Residence: 1902 Bernard Avenue, Nashville Tennessee 37212
Thank you for the opportunity to address the issue of mental health and substance use parity. My name is Sita Diehl. I live in Nashville, Tennessee and serve as the Director of Policy and State Outreach for NAMI, the National Alliance on Mental Illness. NAMI is the nation’s largest grassroots organization dedicated to building better lives for the millions of Americans affected by mental illness.
Our 27-year-old son lives with Autism, Major Depressive Disorder and Attention Deficit Disorder. Because my husband is a federal employee, we have had the good fortune to enjoy parity coverage in the Federal Employee Health Plan since the mid-1990s. Our story demonstrates the potential of parity if fully implemented. Our son has provided permission to submit this testimony and fully supports my advocacy on this issue.
When our son was less than three years old, the preschool contacted us with concerns that he was not behaving as most children did. We were frightened because we knew from family history that mental health conditions can derail promising lives. The pediatrician referred our family to the Vanderbilt Child Development Center for a comprehensive assessment, which provided the foundation for early and effective treatment.
Coverage of early identification and intervention provides a tremendous return on investment. Medicaid requires early periodic screening, diagnosis and treatment, but intensive assessments are rarely covered by commercial health plans. Had it not been for public early intervention funds, the assessment would have been financially out of reach for our family and our son’s trajectory would have been very different.
At age six, when our son was actively suicidal, he began seeing a child psychologist. Our health plan covered most of the cost. It wasn’t long before the psychologist recommended psychiatric medication to treat the depression. We were fortunate to live in a community with a child and adolescent psychiatrist, and to have a health plan that covered his care.
Since then the psychiatrist has ceased taking any type of insurance due to low reimbursement rates and high administrative burden; an issue not limited to our experience as I have heard from families across the country. This raises a point about parity in provider rates. To address the mental health workforce shortage, policies should be put in place that enable providers to make a livable wage.
Through his early teens our son experienced several periods of suicidality and had ongoing behavioral challenges at school. However, thanks to excellent mental health treatment he never required costly crisis or hospital care.
With continuing treatment and the self-care skills learned from his clinicians, he excelled in high school, graduating second in a class of over 2,000 students.
We planned carefully as he entered the University of Wisconsin, including a warm hand-off from the child psychiatrist to a psychiatrist in his new home. Thankfully, he was covered by our health plan to age 26 by which time he was working as a research assistant and could purchase the university health plan.
He is now transferring to the Massachusetts Institute of Technology (MIT) where he will pursue a doctorate in chemistry. He knows himself very well and manages his care with the help of a psychiatric nurse practitioner. Parity mental health coverage has provided him with the treatment he needs to reach his full potential.
Our story stands in stark contrast to many I hear in my work with NAMI. For the past three years, my colleagues and I have surveyed over 2,000 families each year about their experience with mental health coverage. We have learned about many young people whose families are hard pressed to find in-network providers. They often face high out of pocket costs, which can place care out of reach and lead to dependence on public benefits. Families and providers are forced to joust with health plans to obtain approval for care. These burdens hit at a time when they are already overwhelmed by the crisis of mental illness. It pushes countless families to their limits.
We can do far better by assertively enforcing federal parity law. Here is what is needed:
- Federal and state regulators should require periodic reports from insurers to demonstrate parity compliance, and should follow up assertively when discrepancies emerge.
- Regulators should monitor health plans to ensure parity in provider rates and application of administrative procedures.
- Early identification and intervention should be strengthened by requiring mental health screening and assessment as a benefit in all public and private insurance plans.
- Consumers should be educated on their rights under parity law, complaint procedures and the assistance available to file complaints.
Federal parity law is intended to end discrimination in coverage of mental health and substance use conditions. I urge you to fulfill the promise of parity and give more Americans the opportunity to lead healthy, productive lives.
Thank you for the invitation to provide testimony on this important topic. NAMI stands ready to work with you on effective enforcement of mental health parity at the federal level and in communities across the country.