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GAO: Mental Health Exclusions Getting More Specific

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The U.S. Government Accountability Office (GAO) found many more types of mental health and substance abuse treatment exclusions in employers’ 2010 and 2011 plan documents than in the 2008 documents.

John Dicken, a GAO director, talks about those results in an introduction to a GAO review of behavioral health treatment exclusions in group health coverage.

The new report is a followup to a report the GAO released in November 2011.

GAO investigators asked participating employers a number of questions, including whether their most popular health plan excluded coverage for any specific treatments related to mental health or substance abuse. 

The investigators received detailed responses to the question from just 81 employers for the 2011 study and 96 employers for the new study.

Dicken warns against taking the findings too seriously.”Given our overall response rate of 24%, our survey results are not generalizable,” Dicken writes in a letter summarizing the results for Rep. George Miller, D-Calif., the highest ranking Democrat on the House Education and the Workforce Committee.

But the percentage of employers reporting at least one behavioral health treatment exclusion increased to 41% for the new report, from 33% for the previous report.

Since the 2008 plan year documents were developed in 2007, employers’ overall benefits costs have increased significantly, the economy has weakened, and the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) has required employers that offer coverage for behavioral health services to apply the same plan design features to behavioral health and general medical health services.

States such as California and New York have broader mental health parity laws.

The researchers found that the number of employers imposing behavioral health exclusions fell or held steady for a few disorders, such as alcoholism, conduct disorders and sexual disorders.

But the number increased by 200% or more for a number of treatments, such as vocational counseling and sex change counseling. The number also increased rapidly for treatments for conditions such as  autism, behavioral disorders and mental retardations.

Under the treatment exclusion heading for “behavioral disorders/problems/delays/counseling/health/training/services,” for example, GAO investigators found one 2010/2011 exclusion for “special education, school testing or evaluations, counseling, therapy or care for learning deficiencies or behavioral problems.”

Another exclusion under the same heading states that the employer that offered the plan excludes coverage for “educational services and treatment of behavioral disorders, together with services for remedial education including evaluation or treatment of learning disabilities, minimal brain dysfunction, developmental and learning disorders, behavioral training, and cognitive rehabilitation. This includes services, treatment, or educational testing and training related to behavioral (conduct) problems, learning disabilities, or developmental delay.”

Under “attention deficit disorder,” the GAO found a 2010/2011 exclusion for “charges for education, learning disabilities, job training, behavioral problems or attention deficit disorders whether or not provided by a facility that also provides medical or psychiatric treatment” and a second exclusion for “any care that extends beyond traditional medical management for autistic disease of childhood.”

When reviewing the 2008 plan documents, the GAO found no attention deficit disorder exclusions.

Similarly, the GAO found no feeding disorder exclusions in 2008 and two long examples of feeding disorder exclusions in the 2010/2011 documents.


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