GAO: Mental Health Exclusions Getting More Specific

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.