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Mass. mental health benefits could expand

STEVE LEBLANC

An initiative expanding insurance coverage for a long list of mental health diagnoses is making its way through the Legislature.

House lawmakers approved the bill, which would lift existing caps on the number of office visits insurance companies must offer for people suffering from a range of mental ailments, from alcoholism and eating disorders to substance abuse and post traumatic stress disorder.

The bill builds on an eight-year-old mental health parity law that sought to guarantee people suffering from mental illnesses would receive the same health benefits as those with physical illnesses.

Under the existing law, insurance companies are required to offer coverage to those with biologically-based mental illnesses, such as schizophrenia, bipolar disorder and major depressions, with no cap on the number of treatments.

For those with non-biologically based mental health ailments and addictions, the 2000 law allowed caps of 24 office visits and 60 inpatient days.

The House bill would erase the distinction and require equal coverage for all mental illnesses and addiction disorders listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, which is used by mental health professionals.

“We just say that all diagnoses need to be treated like all other medical conditions,” said bill sponsor state Rep. Ruth Balser, D-Newton. “You wouldn’t have a medical limitation where you would treat the first two heart attacks, but if you have a third, you’re on your own.”

Balser said the treatments would still need to be shown to be medically necessary.

She also said the bill would also help erase some of the stigma that attaches to people seeking treatment for mental health problems.

The state’s insurance companies oppose the bill, which they said would require expanded coverage for hundreds of diagnoses, from caffeine-induced sleep disorders to academic problems.

That would drive up premiums at a time when the state is struggling to reign in costs associated with the landmark health care reform law.

“We are concerned that the bill goes too far, that it costs too much at a time when the economy [is] in very critical shape,” said Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans.

Balser said the bill could result in a small increase in premiums of less than 1 percent, and could end up saving the state money it now spends on substance abuse detox.

Buyse disagreed, saying one major insurer had to boost premiums by 4 percent when Vermont passed a similar law.

“People already have very generous benefits and we think this is a very precarious time to be adding a very expensive new mandate,” Buyse said.

Supporters of the bill argue that the distinction between biological and non-biological disorders has grown increasingly fuzzy over time with more research suggesting many disorders believed to be non-biological, like addictions or eating disorders, may in fact have biological roots.

They also argue that whatever the cause, the need for treatment is real, whether the patient is a battered wife or a veteran suffering from post-traumatic stress disorder.

The bill is now before the Senate Ways and Means Committee. Gov. Deval Patrick said he hasn’t seen the bill yet.

The effort to expand coverage in Massachusetts mirrors a similar push on the federal level being championed in the U.S. Senate by Massachusetts Sen. Edward M. Kennedy and in the House by Kennedy’s son, Rep. Patrick Kennedy, D-R.I.

Earlier this year, the U.S. House approved Patrick Kennedy’s bill requiring equal health insurance coverage for mental and physical illnesses when policies cover both.

The House vote followed action by the Senate, which passed a narrower version of the bill backed by the elder Kennedy last September with support from business and insurance groups.

The two chambers are hoping to hammer out a compromise version.

The White House said it favors the Senate bill because it addresses the need to treat mental illnesses with the same urgency as physical illnesses but wouldn’t significantly raise health care costs.

(Associated Press)