Last month Colorado's legislature passed the first state-mandated mental health parity bill since 1995. Governor Roy Romer (D) is expected to sign the bill into law, said Robert Clark, M.D., president of the Colorado Psychiatric Society.

"We are very delighted that our legislature found its way clear to pass a limited parity bill. This is a real testimony to the efforts made by the Colorado Psychiatric Society, the Colorado Alliance for the Mentally Ill, the Mental Health Association of Colorado, and the state legislators who introduced and supported the bill," Clark told Psychiatric News.

Nearly 50 parity bills have been introduced in 27 states including Colorado as of March this year. That is nearly double the number of parity bills introduced last year. Moreover, parity bills are expected to be introduced in eight states this year, according to Katherine Becker, deputy director for state affairs in APA's Division of Government Relations (DGR).

In Indiana and Vermont, parity bills were passed by their respective House of Representatives earlier this year and now await action in the Senate, noted Becker.

As state parity activities increase, psychiatrists and other mental health advocates face a host of issues involving political and coalition dynamics, legislative language such as the scope of the bill and definition of mental illness, cost analysis, and legislative strategies.

For example, several states including Colorado, Florida, and Texas limit their definition of mental illnesses to serious, severe, or biologically based.

Colorado's parity bill mandates that every group policy, plan, or contract "provide coverage for the treatment of biologically based mental illness that is no less extensive than the coverage provided for any other physical illness," reports DGR's March State Parity Page.

The language applies to schizophrenia, schizoaffective disorder, specific OCD, and panic disorder.

In contrast, states such as Georgia, Kansas, and Utah include all mental illnesses in their definition but exclude substance abuse disorders, notes the State Parity Page.

Comprehensive parity bills covering all mental illnesses and substance abuse disorders have been introduced in Arkansas, Hawaii, Iowa, Vermont, Massachusetts, and Oregon.

Becker said the Arkansas bill was particularly innovative because it also requires nondiscriminatory insurance coverage of developmental disorders. The language continues to be negotiated between the bill's sponsors, the mental health coalition, the insurance industry, and the insurance commissioner.

Becker said she recommends that APA's district branches start with full parity bills because the language will be whittled down during the legislative process. However, "if a legislative cosponsor says only serious mental illnesses should be covered, district branches should use that approach. Once a parity bill is enacted, it can always be built upon."

Becker also recommends that district branches build coalitions with patient groups, other mental health provider groups, and the state medical society, when possible. This approach was successful in getting the Colorado parity bill passed last month.

The Illinois Coalition to Stop Insurance Redlining of Mental Illness, led by the Illinois Psychiatric Society, was successful in getting a parity bill voted favorably out of the House Health Care and Human Services Committee earlier this year. The bill requires insurers to cover serious mental illnesses under the same terms and conditions as other illnesses and diseases.

Becker said innovative language in the bill requires insurers to offer coverage as well for "reasonable and necessary treatment for mental disorders other than serious mental illnesses," thus broadening the scope of the bill.

The coalition has 16 diverse members including the state Alliance for the Mentally Ill, the state Mental Health Association, social workers, family therapists, counselors, and the League of Women Voters.

Becker commented that the League of Women Voters was "influential in getting the legislature to sign on."

Another innovative strategy was the coalition's conducting a statewide telephone poll of 804 registered Illinois voters. The results showed that 88 percent of voters favor a state law to require insurance companies to provide equal coverage between mental and other medical illnesses, according to the State Parity Page.

(Psychiatric News, April 4, 1997)