Mental Health

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Mental Health the Americans with Disabilities
Act The Mental Health Parity Act and the ADA

• Presented by the Wisconsin Disability Program
  Navigators - Navigating and Connecting Wisconsin
  Disability
• and Employment Resources and Systems

2
Federal Regulations

• Two pieces of regulation have impacted how
  employers treat mental health issues.

• The Federal Mental Health Parity Act of 1996
  became effective on January 1, 1998.
• The Equal Employment Opportunity Commission
  (EEOC) issued guidelines on the Americans with
  Disabilities Act (ADA) and Psychiatric
  Disabilities,1998.
• This presentation will describe these two pieces
  of legislation/regulation and their impact on
  employers.

3
The Mental Health Parity Act

• Applies to companies with 51 or more employees.
• Employers must provide coverage for diagnosis and
  necessary treatment of mental illness under the
  same terms and conditions applied to other
  medical conditions.
• Applies to medical plans renewed on or after
  January 1, 1998.

4
The Mental Health Parity Acts Major Provisions

• A plan must provide equal lifetime and annual
  maximums for medical and mental health benefits.
  If a group health plan does not provide dollar
  limits for medical or surgical benefits, it
  cannot apply them to mental health.
• A plan cannot impose dollar limits for hospital
  stays or outpatient visits. However, it can
  impose day limits on hospital stays and
  outpatient visits.
• The Act excludes substance abuse and chemical
  dependency from the requirement of equal
  maximums.

5
Mental Health Parity Act Exemptions
Exemptions

• An employer can claim exemption from the Act if
  compliance results in a one-percent or higher
  increase in the overall cost of the group health
  plan's premiums. The burden is on the employer to
  prove the increase, and the Act does not explain
  how employers would claim an exemption.

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The Americans with Disabilities Act

• The Americans with Disabilities Act (ADA) was
  passed in 1990 and it prohibits discrimination in
  employment against individuals with disabilities.
  Earlier this year the EEOC issued the guidelines
  on ADA and Psychiatric Disabilities.

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Americans with Disabilities Act (ADA) Guidelines

• The guidelines were issues to

• Respond to questions and concerns expressed by
  individuals with psychiatric disabilities
  regarding the ADA,
• Answer questions posed by employers about how ADA
  applies in the context of psychiatric
  disabilities, and
• Facilitate the full enforcement of the ADA with
  respect to individuals alleging employment
  discrimination based on psychiatric disability.

8
ADA Definitions of Mental Impairment

• The ADA defines "mental impairment" to include
  "a ny mental or psychological disorder, such as
  . . . emotional or mental illness." Examples of
  "emotional or mental illnesses" include major
  depression, bipolar disorder, anxiety disorders
  (which include panic disorder, obsessive
  compulsive disorder, and post-traumatic stress
  disorder), schizophrenia, and personality
  disorders.

9
Employer Confidentiality

• Employers must keep all information concerning
  the medical condition or history of its
  applicants or employees, including information
  about psychiatric disability, confidential under
  the ADA. If employees ask questions about a
  coworker who has a disability, the employer must
  not disclose any medical information in response.

10
Reasonable Accommodation

• An employer must provide a reasonable
  accommodation to the known physical or mental
  limitations of a qualified individual with a
  disability unless it can show that the
  accommodation would impose an undue hardship.

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Reasonable Accommodation Examples

• Time off using accrued paid leave or unpaid leave
  
• Modified work schedules
• Allowing more frequent breaks
• Changing management style such as offering more
  frequent and detailed job guidance
• Changing the work environment, such as making it
  quieter and easier for the employee to
  concentrate

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The ADA does not protect

• Sexual behavior disorders
• Compulsive gambling
• Kleptomania
• Pyromania
• Psychoactive substance use disorders resulting
  from current illegal use of drugs

• Employees with a protected mental disability are
  not exempt from the company's standards of
  conduct and disciplinary procedures

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Final Thoughts

• At first glance it appears that compliance with
  these regulations will be costly to employers.
  That may be true. However, the other side of the
  equation is the cost of not treating and
  accommodating mental disabilities. Studies have
  shown that mental disorders are a major source of
  absenteeism, low productivity, accidents,
  turnover, job dissatisfaction and interpersonal
  conflict.

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Final Thoughts

• In addition, depression is associated with higher
  levels of disability than most chronic physical
  disorders. Untreated mental health disorders can
  lead to more costly medical treatment and workers
  compensation claims. One study of Medicaid
  patients with chronic illnesses showed a drop in
  medical costs when the patients received
  psychotherapy.

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Final Thoughts

• Providing accommodation and health care for
  employees with mental disabilities may result in
  some cost savings, although it will be difficult
  to measure how much. Since employers must comply
  with the law, the best approach is to work with
  the health care providers to control costs.

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Cost Control Techniques

• Examples

• Using Employer Assistance Plans (EAP's)
• Encourage the use of outpatient treatment rather
  than more expensive inpatient services
• Establish a preferred provider network
• Install managed care techniques such as case
  management

17
Update

• Legislative Happenings

• September 2007 The Senate passed the Mental
  Health Parity Act, S. 558. This bill is to
  provide parity between health insurance coverage
  of mental health benefits and benefits for
  medical and surgical services. The bill now goes
  on to be voted on in the House. Status
  http//www.govtrack.us/congress/bill.xpd?bills110
  -558
• March 2008 The House of Representatives gave
  overwhelming approval (268-148) to the Paul
  Wellstone Mental Health and Addiction Equity Act
  of 2007 (H.R. 1424), sponsored by Rep. Patrick
  Kennedy (D-RI) and Rep. Jim Ramstad (R-MN).  The
  bill would require that mental health benefits be
  equal to medical and surgical. The bill now goes
  on to be voted on in the Senate. Status
  http//www.govtrack.us/congress/bill.xpd?billh110
  -1424

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Resources

• National Resources

• Equal Employment Opportunitys Commission
  http//www.eeoc.gov/docs/psych.txt
• U.S. Department of Justice
  http//www.usdoj.gov
• Job Accommodation Network http//www.janweb.icdi.
  wvu.edu
• State Protection Advocacy
  http//www.ndrn.org

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Resources

• State Resources

• National Alliance on Mental Illness Wisconsin
  http//www.namiwisconsin.org
• Wisconsin United For Mental Health
  http//www.wimentalhealth.org
• Mental Health America of Wisconsin
  http//www.mhawisconsin.org
• Wisconsin Department of Health and Family
  Services Mental Health Resources
  http//www.dhfs.state.wi.us/mentalhealth

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• Presented by
• Wisconsin Disability Program Navigators
• For more information or to locate a Navigator
  near you, go to www.eri-wi.org/Navigators.htm.