Payers Prepare for MHPAEA-Mandated Changes to Behavioral Health UM


Share on LinkedIn

Often called the last great taboo, the burden of mental illness on health and productivity in the United States and throughout the world has long been underestimated.

One in 17 adult Americans suffers from a serious mental illness. Many of these people suffer from more than one disorder and substance abuse condition at any given time, placing a substantial burden on individuals, families, the healthcare system, the economy and government.

Beyond the personal cost of these conditions, mental health and substance abuse result in lost employee productivity, increased medical expenditures, and other costs including those resulting from social services, law enforcement, judicial and penal activities.

Tough trend, tough story—does recent legislation offer hope? Congress enacted the Peter Wellstone and Paul Domenici Mental Health Parity and Substance Abuse Equity Act into law in 2008. This new law amends the Mental Health Parity Act of 1996 to require that group health plans of 50 or more employees, that provide both med-surge and behavioral health benefits, do so equitably.

This sets the stage for insurers to take a closer look at the holistic member view necessary for the best behavioral health and medical disease management.

Members of the MEDecision Clinical Programs and Clinical Products teams conducted a really interesting webinar last week focused on member-centric behavioral healthcare management. The team reviewed immediate considerations for health plans as they prepare for the upcoming changes mandated by the Federal Mental Health Parity and Addiction Equity Act.

They discussed the legislation’s implications for health plans with a special look at how it’s going to impact behavioral health UM workflows. The webinar offered really good insight into the societal, economic and regulatory factors that are driving insurers to increase access, improve outcomes and control costs for mental health and substance abuse care; along with the relationship between medical and behavioral health and how it’s important for payers to balance both in order to maintain a more holistic view of members.

There are definitely a lot of things for insurers to consider as behavioral health takes on greater significance for them, but the MEDecision group did an excellent job of making sense of it all.


Please use comments to add value to the discussion. Maximum one link to an educational blog post or article. We will NOT PUBLISH brief comments like "good post," comments that mainly promote links, or comments with links to companies, products, or services.

Please enter your comment!
Please enter your name here