Individual Contribution

Group Analysis Paper

Teliyah Jeter, Ki’ana Hall, Taliaha Ladd, Sharon Moorer, Quinesheta Powell, Alexandria Campbell, Jake Hemeyer, and Frederick Menefee

Department of Social Work, Alabama A&M University

SWK 511: Social Welfare Policy and Services II

Dr. Cassandra L. Scott

April 9, 2022

Policies and Programs

In the past, many policies and programs were developed to address mental health issues. A few of the policies and programs used include the Mental Health America (MHA), the National Health Act, the Mental Retardation Facilities and Community Health Centers Construction Act, the National Alliance for the Mentally Ill, and the Housing Assistance Council (HAC). Clifford Beers created the Mental Health American which was known as the National Committee for Mental Hygiene in 1909. The program was implemented to better the lives of the mentally ill in the United States such as through study and advocacy. A number of government programs have also contributed to the improvement of the U.S. mental healthcare system. Harry Truman passed the National Mental Health Act in 1949, which led to the establishment of the National Institute of Mental Health. This act authorized government funding for research into the causes and treatments of mental illness. The Mental Retardation Facilities and Community Health Centers Construction Act were passed by Congress in 1963. The act provided funding for the establishment of community-based mental health services. It was later in 1979 that The National Alliance for the Mentally Ill was founded. As a result of this act, people suffering from serious mental illnesses could receive support, education, advocacy, and research services. It was the largest non-profit organization in social mental health dedicated to improving the lives of millions of Americans impacted by mental illness. The Mental Health Parity Act of 1996 marked a first step toward ending such discriminatory insurance practices. The law establishes a premise that there shall be no gap between health insurance benefits for mental health and health insurance benefits for general health care. However, the Act only authorized employer health plans with more than fifty employees with mental health insurance to establish separate annual or lifetime spending restrictions for mental health care. While the 1996 Act was a significant step forward, it did not result in fundamental reforms. The HAC program, formerly known as Housing Assistance Council, was a social welfare program used in the past. The nonprofit organization was founded in 1971 and devoted its efforts to low-income rural housing development throughout the United States.

The HAC created the Section 811 Supportive Housing Program for Persons with Disabilities which provided funding to developers of housing for disabled, low-income households. This specific program was created in 1990 and it was for the physically disabled, developmentally disabled, or chronically mentally ill people (18 and older) with very limited incomes and their families. Mental health policies are created to establish a vision for the future. This aids in the prevention, treatment, and rehabilitation of mental disorders and finally the advancement of mental health within the community. Some mental health programs that were previously developed to deal with the problem are mental health screenings, Back To School, and Life On Campus. Mental Health America offers online screening tools for people who may suffer from depression, anxiety, bipolar disorder, eating disorders, post-traumatic stress disorder (PTSD), alcohol and substance use, early psychosis, work health, as well as screenings that are youth-focused and parent-focused. After finishing the screening, individuals will get immediate results, resources, and education. MHA also offers other programs as well. The Back to School program was created for a feeling of being safe returning back to school. Some teens and kids have struggled with the feeling of safety or stability due to trauma created by COVID-19. It has changed our normal everyday life. Some children may have had to stay home in an abusive situation, or even struggle with finances. MHA’s 2021 Back to School toolkit, aims toward assisting parents, students, teachers, and administration to recognize that feeling unsafe can take a toll on mental health and school performance. The Back to School program also aids in helping young people who are dealing with mental health.

It is now more common to have mental health issues on college campuses across America. It is important to have accessible screening and early diagnosis of mental health so that proper treatment can be offered to improve one's college experience. This aids them in being successful. When going off to college people will be in a new living environment, sometimes this can be a very stressful situation for the student. Although stress is a part of any college student's life, too much stress can have a very negative impact on the student's health. Being able to identify the early signs of stress and knowing how to manage it can be great for your mental health. A collective of KCAD Digital Art and Design students created a film for Mental Health America as a part of the EPIC project. A key purpose of the animation is to persuade people with a suspicion of mental illness to undergo screening on the MHA website. It is so important for us as social workers to know that these resources are available to our clients who may suffer from any form of mental illness. MHA has made it easy to access their help for any age. This stood out to us because usually many organizations will use one program for all ages, but MHA sees how crucial it is to have specific programs for different age groups. MHA with these programs and policies has been to help attack mental illness among the American population.

Changes to the Act

The Mental Health Parity Compliance Act added some changes in 2021. One major change to this act is that it “requires federal agencies to issue MHPAEA guidance and step-up parity enforcement for NQTLs” (Kate Pestaina et al., Mental Health Parity Compliance Gets a Boost in 2021 Spending Act). The NQTLs requirements are as follows:

1. Medical-management standards

2. Prior authorization requirements

3. Methods to determine provider reimbursement rates

According to the DOL, “health plan participants to request information about the processes, strategies, evidentiary standards, and other factors” (Kaye Pestaina et al., Mental Health Parity Compliance Gets a Boost in 2021 Spending Act).

Other changes to the acct would be that it would oversee compliance with federal law, provide more data on parity coverage, and patients would have more ways to appeal claim decisions. Outside of these changes, the individuals who are responsible would be as follows:

1. Insured plans carrier – responsible for compliance

2. Insured plan sponsors - responsible for notifying if a federal or state authority finds a parity violation

All of these things are put into place not only help the insurance carriers/sponsors but also the clients as a whole.

Mental Health Parity Act Of 1996 : The Initiation and the Supporters

Mental health has been perceived as not being as important as physical health. Mental health is essential to leading a healthy life. Many believe that it is the responsibility of the family to take care of the mentally ill. Mental health care and care for the mentally ill have not been recognized in the same way as general medical care. The idea of mental health parity came about as a result of the inequity in mental health coverage by insurance companies.

The Mental Health Parity Act was initiated by members of congress. However, along the way, psychologists, mental health advocacy groups, social workers, consumer groups, health care professionals, and members of the community, fought for fair and equal health insurance coverage for mental health.

Mental health advocates were the first group of people to address inequities in healthcare coverage of physical and mental health in the 1950s. Parity is the equal insurance coverage of mental and physical conditions. Mental Health advocates brought attention to the unequal provisions of coverage by health insurance companies (Popple, P. & Leighninger, L, 2015).

Members of Congress, Members of the American Psychological Association, Psychologists, mental health advocates, and members of the community, promoted the Mental Health Parity Act.

The 1960s saw the first mandate for mental health insurance parity. during President John F. Kennedy's term (Shockley, 2010). President Kennedy had a personal experience on the impact of mental illness. His sister, Rosemary, was diagnosed with a mental illness. President Kennedy proposed and signed the Community Mental Health Act in 1963. The US Civil Services Commission was asked to require that the Federal Employee Health Benefits Program (FEHB), which is the health insurer for federal employees, cover psychiatric illness equitably to physical medical care. Two national insurance plans that provided coverage for federal employees were ordered to provide mental health coverage at the same level as general medical care was covered (Barry, Huskamp & Goldman, 2010).

Mental Health advocates continued the fight for fair and equal coverage of mental health services. The 1970s and 1980s saw a rise in managed care by health insurance companies. During these years private insurance companies were allowed to cut back on the cost of coverage that was imposed by the parity mandate. It was during these years that the state legislature became actively involved in making improvements in mental health care benefits provided by insurance companies.

Members of the American Psychological Association joined the fight for mental health parity in the early 1990s. Advocates for parity continued to advocate and fight for equitable coverage. Federal lawmakers enacted the first federal mandate for mental health parity in 1992. The legislation was introduced by two Republican senators, Senator Pete Domenici, a conservative Republican from New Mexico, and Senator John Danforth an independent from Minnesota. They were not successful in getting the bill passed at that time. Nonetheless, the senators continued to push for parity legislation. the effort for parity.

President Bill Clinton attempted to reform healthcare in 1993. Within his healthcare reform package was a smaller package that would have required some parity for mental health services. The failure of the health care reform bill was yet another failed attempt at mental health parity. The energy and enthusiasm to gain mental health parity did not die with the healthcare reform bill. The senators gained more momentum and continued to fight for mental health parity.

In 1995 Senator Nancy Kassebaum introduced a bill that would revisit parity in mental health coverage. It was called The Health Insurance Reform Act (Boden, B., Cochand, B. Nelson, C. & Potter, R. 2004). The act passed. However, it failed to include parity. The preclusion of parity in this act led to Senator Domenici and Senator Paul Wellstone introducing a comprehensive parity bill. The senators had hoped to include the plan in the Health Insurance Portability and Accountability Act (HIPAA). The senators had yet another failed attempt at gaining mental health parity.

By 1996 Senator Domenici and Senator Wellstone gained support for parity from other senators, like Phil Gramm from Texas and other public figures. They recognized the impact of mental health on their own family. They got on board with the business of passing the legislation to establish parity (Popple, P. & Leighninger, L, 2015). Representative Roukema Marge, a Republican from New Jersey, introduced the bill to provide parity for mental health benefits under group health plans. The Mental Health Parity Act was passed in 1996. The bill passed in Congress with a vote of 68 to 30.

The passing of the Mental Health Parity act was a victory. However, Senator Whetstone was not pleased with the limitations of the policy. This would not be the end of advocacy and support for fair and equal coverage for mental health care. Senator Paul Wellstone expressed his frustration with the bill stating, “ we didn't get half a loaf, we just got the crumbs but it's a start.” (Barry, C., Huskamp, H., & Goldman, H. ).

Realizing the limitations of the bill he knew that there was still work to be done to ensure equal access to healthcare coverage.

The Mental health Parity Act of 1996 was not as effective as it needed to be in promoting equitable treatments. Federal legislators continued their efforts to pass more stringent mandates. (Shockley, 2010). In 2003 President George W. Bush, the 43rd president of the United States, created the New Freedom Commission on Mental Health. It reaffirmed his support for mental health parity legislation. He believed that the health care system should provide equal treatment for mental illness as physical illness. This showed that a republican president supports parity. (Hogan, M., 2003)

Federal Parity legislation did not address all of the problems of mental health parity. Lawmakers implemented state parity laws to achieve greater parity. One of the shortcomings of the Mental Health Parity Act of 1996 was that it did not include coverage for substance use addiction. The American Psychological Association (APA) began its fight for mental health parity in the 1990s. They were diligent in their work to pass the parity law. They sent letters to congress, met with elected officials, and attended a leadership conference in Washington, The passing of the 2008 Paul Wellstone and Pete Domenici Mental Health Addiction Equity Act was a landmark victory for members of the APA. This Act ensures mental health and substance use coverage for in-network services and out-of-network services used (Novatney, Amy 2008). It is known as the Paul Wellstone and Pete Domenici Mental Health Addiction Equity Act of 2008. This legislation was passed in 2008. It passed in the house with a vote of 263 to 171 and in the Senate with a vote of 74 to 25.

The National Association of Social Workers provides a platform for social workers to be involved in advocacy and education. Social workers were among the advocates pushing for mental health parity. Mental Health advocates such as the National Association of Mental Illness, the National Mental Health Association, and The Barbizon Center of Mental Health Law, are credited for the knowledge base of the Mental Health Parity Act. The Substance Abuse and Mental Health Services Administration were advocates for the inclusion of Substance use addiction the mental health parity ( Boden, B., Cochand, B. Nelson, C. & Potter, R. 2004).

Fair and equal healthcare coverage for mental health and substance use disorders took more than 45 years to be signed into law (Fank, F.G., 2018). Congress played a pivotal role in the passage of the Mental Health Parity Act of 1996. There were members of Congress who were not in favor of the bill. Those members of congress who were in favor of the bill, psychologists, social workers, healthcare professionals, mental health advocates, consumer groups and community members worked long and hard to get the bill passed. The Bill did not pass without opposition. Determined to see equity for mental health and physical health some members of congress refused to give up the fight. The Mental Health Parity Act of 1996 continues to be analyzed to ensure that it is meeting the needs of those living with mental health conditions. This is a social justice issue that social workers will continue to support.

Individuals For the Act

U.S Senators Bill Cassidy, M.D., and Chris Murphy are all for promoting compliance with Mental Health Parity Laws. They are introducing that the act “authorizes $25 million in grants to states to support their oversight of health insurance plans’ compliance with mental health parity requirements, as long as states collect and review comparative analyses from insurers” (Bill Cassidy and Chris Murphy; Cassidy, Murphy, Cardenas, Fitzpatrick Introduce Bipartisan Legislation Parity Laws, 2006). “These are hard times for everyone, and the impact of the pandemic is taking a toll on the mental health of many people in our communities,” said Representative Cárdenas. “Despite this, those who attempt to receive care are far too often met with barriers in coverage. Our legislation will give states the resources needed to successfully implement parity compliance measures and help people access mental health care and treatment on the same basis as any other illness” (Bill Cassidy and Chris Murphy; Cassidy, Murphy, Cardenas, Fitzpatrick Introduce Bipartisan Legislation Parity Laws, 2006). “As states work to implement the new parity law passed by Congress at the end of last year, it is vital that the Federal government provide state insurance commissioners with resources to ensure compliance,” said American Psychiatric Association President Vivian Pender, M.D. “COVID-19 may appear to be subsiding, but discrimination against those seeking behavioral health treatment is a longstanding problem, and we are still dealing with a mental health crisis, the opioid epidemic, and the disparities produced by social determinants of mental health. This legislation is a necessary step to enhance the ability of states to effectively implement the parity law so that patients can access the life-saving care that they need” (Bill Cassidy and Chris Murphy; Cassidy, Murphy, Cardenas, Fitzpatrick Introduce Bipartisan Legislation Parity Laws, 2006).

Opposition Towards the Act

The Alliance for Human Research Protection has its oppositions for the Mental Health Parity Compliance Act. It is noted that the “mental health services and treatments have often done more damage than good” (AHRP Distinguished Advisory Board, 4 Compelling Reasons Against Mental Health Parity, 2006). The first opposition is by Sharon Begley and she uses examples as to how Mental Health Parity does not help. She stated that “evidence is accumulating demonstrating that grief counseling has in many cases done harm. Unlike other fields of medicine, when mental health services are available, they are often forced on people against their will” (AHRP Distinguished Advisory Board, 4 Compelling Reasons Against Mental Health Parity, 2006).

The second opposition is that “drug manufacturers of SSRIs, have concealed as much as 75% of their own clinical trial findings, making essentially false claims based on selected biased findings” (AHRP Distinguished Advisory Board, 4 Compelling Reasons Against Mental Health Parity, 2006). An example of this is that reports published in the Archives of General Psychiatry state that use of antidepressants during pregnancy can cause neurological problems in mothers’ newborn babies. It is also noted that the problems may not last long, but it is the issue of the side effects not being told to the patients.

The third opposition would be that according to the Palm Beach Post, it states that “foster care children are being abused with psychotropic drugs” (AHRP Distinguished Advisory Board, 4 Compelling Reasons Against Mental Health Parity, 2006). After reviewing the files of 1,180 children, most living in therapeutic foster homes, it was recorded that 652 of those children were at least on one psychotropic medication. The issue is that these children have no medical examination on file and the medication was prescribed by primary care physicians and not psychiatrists. It is noted that “one foster teen in a psychiatric ward was so drugged that she acted more like a passive Alzheimer’s patient” (Kathleen Chapman, Mind Drugs Given to Hundreds in Florida Foster Care, 2003).

Lacking Parity

Individuals who oppose having the Mental Health Parity Compliance Act are individuals who fear and struggle that it will not cover certain treatments and that health care will not be affordable. The other issue is that many Americans struggle to find mental health and substance abuse treatment due to it not being affordable. This is because many services fall under the out-of-network umbrella. Another issue is that in 2019, a Milliman study was found and it showed that a multitude of behavioral health providers was outside of their client’s insurance network. This is a problem because patients/clients are not able to get the help they need to be better individuals.

Benjamin Miller, the president of Well Being Trust, stated that the main reason individuals avoid getting care is because of the out-of-pocket costs. It was reviewed in 2021 that all 30 health insurance plans and issuers were out of compliance with the act's rules of parity. Two things that were in the non-compliance category were the following:

1. Limiting access to services to treat individuals on the autism spectrum

2. Excluding coverage of medication for opioid disorder

The way they are trying to deal with these issues is to have the Department of Labor to fine insurers who fail to comply with the laws of the act.

Overall, individuals are against this act because of all the issues that come with it. When it comes to someone's health, an individual should feel secure and protected by their health plans. Health plans should be affordable and cover everything. Health plans not being affordable and not covering a multitude of treatments and disorders is the main reason individuals are against the Mental Health Parity Compliance Act. In the end, if health plans can add these few things and being compliance with the laws of the act, there will be more individuals with health plans.

Effective Approach

Mental health treatment is a challenging issue that requires concerted efforts to achieve positive outcomes. It involves the collaboration of the community, health providers, the government, and other key players like social workers to provide quality mental health care. Other essential players are the insurance providers who are expected to help patients access quality care by providing financial aid. The Mental Health Parity Act was introduced in 1992 to guarantee that insurers play their part in ensuring equal access to mental health care as other patients access physical health care. Based on the Mental Health Parity Act, history teaches that a practical approach to achieving mental health equality is a collaborative process that requires contribution from critical players like insurers who have limited access by finding ways to circumvent the legislation and its amendments over time. This essay elaborates on history's teaching on mental health treatment based on the Mental Health Parity Act.

The Mental Health Parity Act analysis confirms that several Americans with health insurance encounter more challenges in accessing mental health and addiction services than they encounter when seeking treatment for other conditions, especially physical health. Most of the care plans enforce more out-of-pocket spending requirements and more restraining treatment restrictions on addiction and mental health benefits (Thalmayer et al., 2017). Today, new technologies such as MRIs and PET scans allow professionals to examine people's brains and have indicated that addiction and mental health are brain illnesses. However, reimbursement policies have not kept pace with science to ensure equality in mental health treatment like in other health services (Thalmayer et al., 2017). The history of the Mental Health Parity Act shows that insurers have continually found ways to evade the policy requirements, contributing to the highly notable unequal access to mental health services compared to the access to other care services.

Since 1992, advocates and mental health professionals have fought to achieve health care equality for victims of addiction and mental health challenges. As a result, a partial law was passed in 1996, marking the start of actual progress towards mental health equality. The Mental Health Parity Act (MHPA) mandated partial parity by directing that yearly and generation dollar limits in mental health treatment coverage under group health arrangements providing mental health treatment be equal to that set for physical health issues (Sundararaman & Redhead, 2008). Moreover, the law allowed exceptions to employers serving less than 25 workers and did not apply to employers providing self-insured plans (Barry et al., 2010). This first legislation shows that mental health treatment has experienced challenges for a long time. Specifically, the legislation was intended to address the inequality that existed at the time by requiring that insurers provide equal dollar limits as provided for general health issues (Barry et al., 2010). The legislation confirms that people seeking mental health care have faced more challenges in paying for mental health care than when paying to access care services. Moreover, the legislation establishes the difference in opinions between advocates and care professionals, and insurers; advocates noted and acted on the need for effective mental health care that considers mental health as other complications, while insurers thought equalizing mental health care with other care services as unfair and a loss from their end (Sundararaman & Redhead, 2008). Therefore, mental health care has been ineffective due to the lack of collaboration among key players in the sector, including health professionals and insurers.

History teaches that adequate mental health treatment requires updated and collaborative policies that are up-to-date with existing challenges that bring differences between accessing mental health care and physical health services. Despite the 1996 MPHA, mental health care access was still problematic as insurers found new ways to navigate and escape the law. Consequently, the Mental Health Parity and Addiction Equity Act (MHPAEA) was approved in 2008 to correct existing loopholes like discriminatory health care practices against addiction and mental illness victims. The new law aimed to reduce financial and non-financial ways that insurers and their reimbursement plan limited access to mental problems and addiction health care (Barry et al., 2010). It was a collaborative initiative by victims of mental issues and addiction, their families, employers, and professionals in the mental health sector. The MHPAEA mandated that insurance coverage for mental health and substance use problems employ the same restrictions as the coverage for other medical conditions (Barry et al., 2010). This legislation shows the need for collaborative action in ensuring effective treatment for mental health and addiction complications.

Further, it highlights the lack of collaboration between key industry players needed to achieve effective mental health care. Despite initial collaborative efforts to achieve partial equality through the MHPA of 1996, insurers still found ways to evade the legislation and cut short the legislation's envisioned efficacy (Sundararaman & Redhead, 2008). Hence, mental health care policies need frequent amendments to accommodate recent loopholes facilitating inequality in care access.

Equitable mental health treatment also requires simplified policies that promote collaboration among all key stakeholders. Investigations revealed that insurers and health plans have satisfactorily complied with the specific clauses of the legislation. They have complied with mandated cost-sharing requirements and numerical limits on treatments (Thalmayer et al., 2017). Nevertheless, insurers and plans have struggled to meet the complex aspect of the legislation, especially those governing the design and application of managed care practices like preceding authorization, network design, and compensation rate setting, among others (Thalmayer et al., 2017). Due to the noncompliance by insurers and health plans, Congress passed the Consolidated Appropriations Act (CAA) in 2020, detailing new provisions that required health plans and insurers to complete a comparative analysis proving their compliance with the MHPAEA managed care provisions.

Additionally, the conditions needed insurers to avail the analysis to the US Labor Department and state regulators upon request. These efforts aimed to increase accountability and transparency regarding mental health and addiction treatment coverage by health plans and insurers (Centers for Medicare & Medicaid Services, 2022). New simplified policies such as those of the CAA have improved mental health care equality with other services by ensuring that insurers and health plans show their commitment to achieving effective mental health care. Additionally, the CAA confirms that adequate mental health treatment requires collaborative efforts from key players like insurers and frequent policy amendments to seal any loopholes limiting equity in mental health access.

The history of the Mental Health Parity Act has shown that effective care for the problem requires concerted efforts from parties like the community, care professionals, government, and insurers. Victims of mental health and addiction disorders have faced more pronounced barriers in accessing care services than when seeking other general health services. Progressively, the government has updated the Mental Health Parity Act to seal existing loopholes that insurers and health plans use to hinder mental health access equality. Effective treatment will require continuous and collaborative amendments to ensure accountability and transparency; hence, equitable access to mental health care is comparable to general health care access

Ineffective Approach

There has been discrimination in health insurance for mental health coverage. Substance abuse has also been existence despite the anti-discrimination passing. There ought to be revered arbitrary discrimination. In this case, legislation is needed. The mental health of individuals is essential to the overall health of the person. The treatment given for mental health works. Investigations have discovered that adjusting specialty conduct wellbeing and general health advantages will either not increment all-out medical care costs or will increment them by just an extremely unobtrusive measure of all-out medical care expense The genuine expense lies in not treating social wellbeing problems. (Goldman, Frank, & Morrissey, 2019).

The Mental Health America Policy Position and Call to Action was taken on in September 2006, preceding the section of the Mental Health Parity and Addiction Equity Act in 2008. Notwithstanding, as will be framed in this toolbox, there are still holes in emotional well-being and substance misuse equality and the standards of the arrangement proclamation are as yet pertinent. On a commonsense note, there are references in the arrangement paper that will be that keep on being applicable and important in arguing for full equality. The target population is the individuals that are living with mental illness. Mental Health America aims to promote mental health to all. The federal government works with the states to address the issue of mental health. The federal government regulates the systems and the providers and also protects the rights of the consumers. The federal government also provides funds and services in support of innovation and research.

Available mental health scholarship has unearthed and documented various barriers that keep people from achieving good mental health. One of the foremost obstacles to the issue revolves around the social stigmatization of mental illness. In some rural areas with low educational achievement index, mental illness is considered taboo and people shy away from discussing any issues related to their mental health. People are either not aware or just ignore existing psychological counseling interventions, leading to the exacerbation of their mental health. This barrier needs to be reversed by creating awareness of the adverse effects of stigmatizing mental illnesses and the benefits of seeking early medical interventions.

Before the adoption of the ACA, people with mental health problems could not get insurance because companies refused them. This situation has led to severe consequences and a high level of deaths due to suicides or overdose. The ACA has made insurance reduce insurance costs for low-income populations, which are typically more prone to abuse and mental issues. The abolition of the lifetime limit, or the maximum amount of money allocated by insurance to cover medical expenses during life, also is a significant positive change. Consequently, the ACA has affected a considerable part of the population by enabling them to remain healthy. It is suggested that individuals should be encouraged to take mental health examinations regularly, as one of the barriers to effective treatment entails failing to recover completely due to a late diagnosis of the mental illness. Other obstacles have been discussed as well, including social and cultural stigmatization, perceived mistrust of healthcare professionals, and lack of specialists. (Dicken, 2000).

Historical Change of the Policy

Change is an important part of our lives, whether it's changes in systems, corporations, and businesses, relational affairs, lifestyle, health, or even personal development. Change allows us as humans to move forwards to the frontier of life; to experience new opportunities, and possibilities, and more times than not, change is for the better. Change can be seen all throughout the social policy. Change in policy is fundamental, and at a particular moment in time, a crucial strategy that must be implemented for the progression of social change. In fact, in the concept of social policy, policy change is a widely researched area. Many researchers who study policy change look for “what works” or “when do policies change” in order to better understand this topic, and possibly create more well-rounded theories for educational purposes. Next, the terms policy change and policy reform here are two different concepts. “It is important to distinguish ‘policy change’ from ‘policy reform’ as the terms are often used interchangeably in the literature. Policy change refers to incremental shifts in existing structures or new and innovative policies. Reform usually refers to a major policy change. To take the example of health care, reform is ‘the process of improving the performance of existing systems and of assuring their efficient and equitable response to future changes.” (Bennett and Howlett 1992). Change in other terms can be put as turning into something totally different or adding new. While reform is closer to fixing from bad to new. In the context of the Mental Health Parity Act of 2019, this policy went through profound changes that have brought it to the present moment or at the place it did today. This specific policy, previously discussed in further analysis, can be placed in the umbrella of mental health. Specifically focusing on equality in insurance coverage. The changes prior to this policy in mental health are monumental, and not concrete, but abstract in the process of developing and changing for social change for mental health.

The changes prior to the Mental Health Parity Compliance Act of 2019 can be brought back to the beginning of 1946 when times were different. Nevertheless, times were changing progressively. The beginning of the recognition of mental health was at war. Prior to the early 1990s mental health altogether was never widely recognized as an important issue. In fact, mental health was classified as a spiritual awakening, witchcraft, or an angry god. As a science, medicine, and awareness spread throughout the timeline of human existence. We finally put a notice on mental health, and possibly the first milestone was accomplished historically. This milestone was the National Mental Health Act of 1946 passed by Harry Truman. The (NMHA) for short, established and equally provided funds for the National Institution of Mental Health. This act was so valuable because it created mental health to be recognized as an illness, and a national significance for treatment and thus a priority. This mental health act was highly influenced by the dramatic trauma-induced experiences of the World Wars. After WWII, many mentally damaged veterans and draftees constituted a huge majority of the population. At this moment in time, the government knew it had a problem on its hands. The immediate change in awareness that putting veterans in institutions when they could be treated through evaluation was the spark of the awareness of mental health here in the United States. This perhaps was the first stepping stone in the changes of many that made to reach the Mental Health Parity Compliance Act.

Next, as there was an abundance of influences, changes, and landmarks that lead to the significance and discovery of mental health. Perhaps the one most notable for its breakthrough to the Mental Health Parity Compliance Act was the change in 1996. This act was huge in the context of changes made to the Mental Health Compliance Act of 2019. The Mental Health Parity Act is legislation signed by the United States government that requires annual or lifetime dollar limits on mental health benefits to be no lower than such dollars on medical or surgical benefits offered by group health plans or insurance offered by group health plans. This sparked a highlighted change within mental health awareness. Prior to the Mental Health Parity Act, insurance companies were not required by law to cover mental health care, so the treatment was always limited. Mental health was beginning to be more noticeable to the eye of the public but even more equal medical problems in regard to value. This was an important changing process in policy change, or specifically insurance change in mental health because it brought upon a general understanding and awareness that mental health did not hold the same weight as medical health did in the past in the context of illnesses. As a result, having unfair and unproportionate consequences. It is important to note that the Mental Health Parity Act did not mandate coverage for mental health treatment, rather, it only applied to group health plans that offered mental health benefits. However, this law was another powerful sense of change in the right direction for mental health, and its implications for the Mental Health Parity Compliance Act.

The next change to the Mental Health Parity Compliance Act was the added revised change to the Mental Health Parity Act. In the decade after the passage of the MHPA, many states passed their own mental health parity laws, some going further than the Mental Health Parity Act toward full parity. With this ongoing process, the ‘adding new’ to the MHPA came to be the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). “The MHPAEA requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.” (2010 CMS.GOV). Basically, this is a law passed that prevents health insurance issuers, who provide substance use disorders or mental health benefits from IMPOSING less favorable benefit limitations on those benefits than on medical or surgical benefits. This step perhaps was the biggest step to the passing of the Mental Health Parity Compliance Act, and to continue possibly where it gets its most notable credit for, the reform that followed in 2010. The Mental Health Parity and Addiction Equity Act originally were for group insurance coverage and group health plans, however, was reformed by the Patient Protection and Affordable Care Act, collectively referred to as the Affordable Care Act to apply individual health insurance coverage. Putting health care insurance coverage as the beacon of mental health change. In result, the MHPAEA maintains the structure of the Mental Health Parity Act protections and adds important new defenses, such as increasing the parity requirements to substance use disorders.

Lastly, the final change was the development and passing of the Mental Health Parity Compliance Act. Discussed throughout the paper, the Mental Health Parity Compliance ACT revises the mental health parity rules to require private health insurance plans that offer both medical and mental health coverage to prepare a comparative analysis of non-quantitative treatment limitations. Insurance companies in the past have always searched for loopholes to not pay as much for mental health problems, for the sake of financial gain. These changes that have occurred in the past have been beneficial actions taking place from mental health awareness. From the word “compliance” the bill aims at evaluating how well employer plan sponsors and Health Insurance Carriers are keeping up with the compliance requirements under the main system of MHPA. Today, plan sponsors, or companies for health care, must now complete extensive analysis regarding the expansive plan limits, the Quantitative Treatment Limitations, and Non-Quantitative Treatment Limitations (NQTLs) of their plans. A portion of the compliance act requirements is that each health insurance carrier completes a detailed analysis of your/the plan, written in a full fashion that is operational. This comparative analysis requires health insurance companies to “show their work” in a very detailed fashion.

References

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