Proposed rules that would require insurers to cover mental health and substance use disorders at the same rate as other medical procedures could actually exclude or restrict all benefits for certain treatments.
That is the message the Texas Medical Association sent in a letter this month to the Texas Department of Insurance (TDI), which has drawn up rules to implement a 2017 law that created payment parity for mental health diagnosis and treatment.
TMA backed House Bill 10 in 2017, and expressed “general support” for TDI’s proposed rules in an April 2 letter signed by TMA President Diana L. Fite, MD.
However, exceptions to the rules related to substance use disorder and autism could be an unnecessary burden to patients, Dr. Fite wrote.
For instance, TDI’s plan could exclude or restrict all benefits for treatments for mental health and substance use disorder that result from the illegal use of a controlled substance, the letter said.
“Substance use disorder is a recognized clinical diagnosis, so it is a Catch-22 to establish treatment parity, but then also have provisions allowing a plan to deny treatment stemming from that very diagnosis if the abused substance is illegal,” Dr. Fite said in the letter.
Likewise, TMA believes the new rules could omit primary care physicians from the care of people diagnosed with autism. The letter proposed language that would put the rules more in line with existing Texas insurance code.
“[The letter] makes clear that [physicians] have and continue to support the idea of mental health parity,” Austin psychiatrist Thomas Kim, MD, told Texas Medicine Today. Dr. Kim testified in support of the law on behalf of the law in 2017. “And more importantly it’s going to be [vital] that TDI does this right.”
Before HB 10, payers covered psychiatric visits far less frequently than other medical conditions, he said. For example, companies regularly covered only eight psychiatric visits per year for people with chronic mental health disorders.
“You never see [insurance companies say] you get only eight visits for your diabetes,” Dr. Kim said. “Mental health has always been the red-headed stepchild as far as potential benefits.”