Trends in employer-provided mental health and substance abuse benefits

Monthly Labor Review

Volumn 128, Issue 4, 2005, Pages 25-35

  Morton, John D ^a   Aleman, Patricia ^a  

^a BUREAU OF LABOR STATISTICS   (United States)

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[No Author keywords available]

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EID: 28244446194     PISSN: 00981818     EISSN: 00981818     Source Type: Journal    
DOI: None     Document Type: Review

References (31)

1. The Mental Health Parity Act of 1996 was signed into law by President Clinton as a means of treating mental illness in the same fashion as all other illnesses. Among the Act's provisions, annual and lifetime dollar limits for mental healthcare must be the same as all other illnesses. The Federal Mental Health Parity Act took effect on January 1, 1998 and expired on September 30, 2001; since then, several extensions have passed and the law is still in effect. On December 19, 2003, President Bush signed the Mental Health Reauthorization Act of 2003, extending the expiration date to December 31, 2004. The 108th Congress extended this sunset date to December 31, 2005. Note that the MHPA exempts private establishments employing 50 workers or less. For a more detailed description of the Mental Health Parity Act of 1996, see Haneefa T. Saleem, "New Law Moves Insurance Plans Closer To Mental Health Parity," Compensation and Working Conditions (cwc), on the Internet athttp://www.bls.gov/ opub/cwc/cm20030909ar01p1.htm (visited Sept. 22, 2003). Note that sections of this article include expansions and updates of information, analysis, and data first presented by Saleem in the 2003 cwc.
2. Because no standard errors were calculated for the survey, none of the year-to-year comparisons made in this article could be verified by a statistical test.
3. Inpatient care is defined as facility charges in a hospital related to an acute mental condition. Outpatient care includes treatment in one or more of the following: outpatient department of a hospital, residential treatment center, organized outpatient clinic, day-night treatment center, or doctor's office. If outpatient benefits differed by location of treatment, the location offering the most beneficial coverage was tabulated.
4. Mental Health: A Report of the Surgeon General - Executive Summary (U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999) on the Internet atwww.surgeongeneral.gov/library/mentalhealth/summary.html (visited April 11, 2005).
5. Data for 1997 are from the BLS Employee Benefits Survey (EBS), and those for 2000 and 2002 are from the National Compensation Survey (NCS), which replaced the EBS. For more information on the change to the NCS, see Employee benefits in private industry, 1999, USDL 01-473 (U.S. Department of Labor), Dec. 19, 2001,
6. especially the Technical Note. The 1997 EBS was limited to private industry establishments employing 100 or more workers; the 2000 NCS included all private industry establishments, regardless of their level of employment. Data from both surveys are restricted to full-time employees. The 2002 NCS benefits survey obtained data from 2,924 private industry establishments representing nearly 103 million workers - 79 million full-time and about 24 million part-time. Of the 46.3 million workers in the 2002 NCS with medical care coverage, about 2.2 million, or about 5 percent of the total receiving medical care, were part-time employees. More complete survey results, as well as survey methodology and definitions of terms, may be found at the BLS National Compensation Survey, Benefits, website on the Internet at http://www.bls.gov/ ncs/ebs/home.htm (visited March 15, 2004).
7. Results from the 2002 National Survey on Drug Use and Health: National Findings, National Household Survey on Drug Abuse Series H-22, DHHS Publication No.SMA 03-3836 (U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2003) on the Internet at http://www.oas.samhsa.gov/nhsda/2k2nsduh/2k2SoFW.pdf (visited March 15, 2004).
8. Achieving the Promise: Transforming Mental Health Care in America, Final Report, DHHS Publication No. SMA-03-3832 (U.S. Department of Health and Human Services, New Freedom Commission on Mental Health, 2003) p.3.
9. Achieving the Promise: Transforming Mental Health Care in America, Ibid., pp. 3, 22.
10. See Report of the Surgeon General, 1999, Chapter 6, p. 417 on the Internet at http://www.surgeongeneral.gov/library/mentalhealth/home.html (visited on March 18, 2004).
11. Studies from various published articles included: 1) Ernst R Berndt, Howard L. Bailit, Martin B. Keller, Jason C. Verner, Stan N. Finkelstein, "Health care use and at-work productivity among employees with mental disorders, "Health Affairs (Chevy Chase, Maryland, July/August 2000), p.244;
12. Elyse Tanouye, "Mental Illness: A Rising Workplace Cost - One Form, Depression, Takes $70 Billion Toll Annually," The Wall Street Journal (Eastern Edition) June 13, 2001, p. B.1; and,
13. Michael T. French and Gary A Zarkin, "Mental Health, Absenteeism and Earnings at a Large Manufacturing Worksite," The Journal of Mental Health Policy and Economics, JMHPE 1, 1998, pp.161-172.
14. For more detailed information about evolution and coverage of mental health benefits, see Allan P. Blostin, "Mental health benefits financed by employers," Monthly Labor Review, July 1987, reprinted in Bulletin 2362, June 1990, pp. 96-100.
15. See Roland Sturm, "State Parity Legislation and Changes in Health Insurance and Perceived Access to Care Among Individuals with Mental Illness: 1996-1998. The Journal of Mental Health Policy and Economics, JMHPE 3, 2000, pp. 209-13.
16. For more detailed information on limits imposed on mental healthcare benefits, see Blostin, "Mental health benefits," pp. 96-100.
17. The Mental Health Parity Act of 1996, PL-104-204. Details of the Act and final rules effective December 31, 2004, are on the Internet at http://www.efast.dol.gov/ebsa/newsroom/pr012304.html (visited April 11, 2005).
18. Detailed information about key provisions of the Mental Health Parity Act of 1996 can be found at the National Association of Mental Illnesses - The Mental Health Parity Act of 1996, on the Internet athttp://web.nami.org/update/ parity96.html (visited March 18, 2004).
19. "It's Time to Pass Comprehensive Health Insurance Parity," National Mental Health Association (NMHA) on the Internet at http://www.nmha.org/state/parity/index.cfm (visitedMarch 18, 2004). For more information about mental health see NMHA publications. NMHA is a nonprofit organization dealing with mental health and mental illnesses issues.
20. Richard M. Scheffler and Daniel P. Gitterman conducted an econometric analysis that identifies factors that affect the passage of State parity legislation. Cited in Ruth L. Kirschtein, "Insurance Parity for Mental Health: Cost, Access, and Quality," Final Report to Congress (National Advisory Mental Health Council, National Institutes of Health, 2000) pp. 8-9.
21. Ruth L. Kirschtein, "Insurance Parity for Mental Health: Cost, Access, and Quality," Final Report to Congress, 2000, pp. 8-9. Ibid.
22. More information about the Hay Group simulation models for estimating effects on premium increases caused by the parity law is included in Ruth L. Kirschtein, "Insurance Parity for Mental Health," p. 10.
23. Coinsurance is the percentage of authorized expenses paid by the medical plan. For example, the plan may have a coinsurance rate of 80 percent. In this case, the plan pays 80 percent of covered medical expenses and the participant (employee) pays the remaining 20 percent. In some plans, the coinsurance rate is lower for outpatient mental healthcare than for other services.
24. Prior to 2003, prepaid plans were referred to as health maintenance organizations (HMOS) and indemnity plans were referred to as fee-rbr-service plans or NOH-HMOS.
25. Results from the 2002 National Survey, on the Internet athttp://www.oas.samhsa.gov/nhsda/2k2nsduh/2k2SoFW.pdf (visited March 15, 2004).
26. 10th Special Report to the U.S. Congress on Alcohol and Health: Highlights from Current Research, (U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, June 2000), p. xi.
27. The Economic Costs of Drug Abuse in the United States, 1992-1998, Publication No. NCJ-190636 (Office of National Drug Control Policy, Executive Office of the President, 2001) on the Internet athttp://www. whitehousedrugpolicy.gov (visitedMarch 15, 2004).
28. Greg Martin, "Substance Abuse Parity: State Actions," December 2002, on the Internet athttp://www.ncsl.org/programs/health/forum/pmsap.htm (visited June 22, 2004).
29. The designation of alcohol abuse coverage as more restrictive than that for other illnesses results from a comparison of types of coverage. For instance, if a plan limits inpatient alcohol abuse care to 30 days per year, but the limit on inpatient care for any other illness exceeds 30 days per year, that plan contains separate, more restrictive, limits.
30. For historical perspective and detailed discussion of employer-provided substance abuse benefits, see Marc E. Kronson, "Substance abuse coverage provided by employer medical plans," Monthly Labor Review, April 1991, pp.3-10.
31. In addition, see, Substance Abuse Provisions in Employee Benefit Plans, Bulletin 2412 (Bureau of Labor Statistics, August 1992).