Topics Tag: Collaborative Care

January 21, 2021

Collaborative Care Model

Providing access to mental health care through primary care is the single most important step health systems can take to address the worsening mental health crisis Texas and the nation are facing. The Collaborative Care…

Depression Collaborative Care

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October 30, 2020

Collaborative Care Policy Background

The collaborative care model (CoCM) is a proven tool to detect and prevent suicide and overdose in primary care before they become crises. Unfortunately, less than one in twenty Americans can currently access it. CoCM…

Depression Substance Use Suicide Collaborative Care

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October 13, 2020

Pandemic Fallout: Highlighting the Need for Better Mental Healthcare

The COVID-19 pandemic has laid bare the dire need for broad and affordable access to mental healthcare and resources. The isolation of the last few months, fear of illness, record unemployment and countless other stressors…

Substance Use COVID-19 Medication-Assisted Treatment Collaborative Care

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August 17, 2020

CoCM & MAT to Prevent COVID-Related Suicide & Overdose Deaths (COVID-19 Impact Series, Volume 3)

In April, MMHPI began releasing a series of white papers analyzing the potential effects of a COVID-19 recession on rates of suicide and substance use disorder among the general population and among veterans. In those,…

Depression The Path Forward COVID-19 Suicide Medication-Assisted Treatment Collaborative Care

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November 26, 2019

The Cost of Depression

In the United States, one in five adults (20%) will experience a clinically significant form of depression in their lifetime. About 7.5% of the US workforce has depression in any year. The impact of...

Depression Workplace Collaborative Care

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June 14, 2016

Mental Health Parity

Background on Legislation Laws designed to put mental health coverage on similar footing with physical health coverage are complex and contain gaps that make true parity difficult to accomplish. Parity legislation at both the state…

Collaborative Care Insurance

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Background on Legislation

Laws designed to put mental health coverage on similar footing with physical health coverage are complex and contain gaps that make true parity difficult to accomplish. Parity legislation at both the state and federal levels for mental health and chemical dependency (MH/CD) date back to the 1990s – predating the Affordable Care Act – and are rooted in separate regulations and statutes. In 1996, Congress passed the Mental Health Parity Act (MHPA), which prohibited large group health plans (plans with more than 50 employees) from applying annual or lifetime dollar limits to mental health benefits that were lower than dollar limits for medical and surgical benefits

The Complexities of Parity

Despite decades of statutes and regulations, the complexities and gaps of current parity laws, combined with ineffective enforcement, have allowed most large group health plans and insurers to continue with business as usual. Federal law does not require large employer groups to cover mental health and chemical dependency services and state mandates primarily reach only fully-insured plans. In addition, it is possible for group health plans to “appear” to be in compliance with parity laws by adjusting their plan designs, when the real world application of non-quantitative treatment limits such as utilization review and medical necessity determinations result in more frequent denials for MH/CD inpatient levels of care than those for inpatient medical care.

In addition, collaborative care interventions, which have been shown to uniquely enhance MH/CD treatment outcomes and reduce unnecessary costs, are not commonly reimbursed by benefit plans. While some testimony indicated that plans are investing in this approach, MMHPI is not aware of any availability in markets we have examined closely (e.g., Dallas County).

Additional Reading

In the 85th Legislative Session, Representative Price (R-Amarillo) and Senator Zaffirini (D-Laredo) teamed up to pass HB 10, which expanded the state’s parity enforcement authority to ensure that mental health coverage is treated the same as physical health coverage. Effective September 1, 2017, HB 10 also required the Texas Department of Insurance (TDI) to conduct a one-time data collection and report assessing mental health parity, specifically related to non-quantitative treatment limitations.

Also effective September 1, 2017, HB 10 required the Health and Human Services Commission (HHSC) to conduct a study and prepare a report comparing benefits provided by Medicaid managed care organizations (MCOs) for medical and surgical expenses to those for mental health and substance use disorder (SUD).