NASW Priorities for Health Care

January 2002

Mental Health Care

The National Association of Social Workers (NASW) supports parity for both mental health and substance abuse benefits, which means treating behavioral health illnesses in the same manner as other physical conditions in the construction of health care benefits. Thus, coverage for annual and lifetime limits, co-payments, and deductibles should be consistent with those under medical benefits. NASW will continue to fight for full parity because mental illness is the second leading cause of disability and premature mortality. According to the National Institute of Mental Health (NIMH), one in five Americans (44.3 million) suffer from a diagnosable, treatable mental disorder in a given year but only one-third (14.6 million) receive treatment in any given year. Also, only 50 percent of the individuals who need treatment for substance abuse receive it.Furthermore, clinical social workers are one of the four core mental health provider groups—others being psychiatrists, psychologists, and clinical nurse specialists. Clinical social workers constitute the largest group of mental and behavioral health providers nationwide and often are the sole providers of such services in medically underserved areas. (Roughly 192,000 as estimated by Substance Abuse and Mental Health Services Administration versus roughly 33,400 psychiatrists and 73,000 psychologists). Other social workers also encounter mental and behavioral health treatment issues daily as they provide medical-social services in a variety of settings across the United States. Thus, mental and behavioral health care treatment parity is an issue of utmost importance to all social workers.Mental illness has a significant fiscal impact as four of the ten leading causes of disability in the U.S. and other developed countries are mental disorders: major depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder.

Patients' Bill of Rights and Managed Care

Consumers are concerned about the lack of protections in managed care health plans, especially given that 75 percent of privately insured people in the United States are enrolled in managed care health plans. NASW supports access to quality health care and will continue to press legislators to develop a law that addresses the patients' need for readily accessible services and protection from managed care that includes (but is not limited to) the following provisions:

• Determination of medical necessity by qualified health care providers. Insurance companies or employers are not qualified to assess medical urgency. Only a qualified health care provider should determine the type of care needed by a patient. Prohibition of gag rules and improper financial incentives to providers. A gag rule restricts health care professionals from discussing all possible treatments and medications with a patient and allows the medical professional to discuss only the treatments covered by the health plan. Ability to hold insurance plans accountable. Patients must be able to hold plans accountable for the delay or denial of treatments that are determined to be necessary. Guaranteed access. Patients should have guaranteed access to needed treatments and therapies by in and out-of-network providers and specialists, and not be limited by insurance coverage. This includes clinical, experimental treatments. Direct access to obstetrics and gynecological services. Women should be able to see health care providers for their routine health care without a referral. Continuity of care. The continuance of care should not be jeopardized in the event that a managed care plan no longer covers services provided by a particular physician, the employer changes health care plans, or the patient switches to a new job. Access to all prescription drugs. New legislation should mandate that managed care plans include comprehensive prescription drug benefits and access to all available drugs.
• Protection for providers who advocate for patients. Providers should not be penalized for speaking out on behalf of clients or advocating in support of patients' rights.

Privacy and Confidentiality of Medical Records

NASW believes that it is imperative to keep all personal health information, including psychotherapy records, confidential while still promoting access to high-quality care and continuing research. The organization will work toward social policies with more respect for confidentiality that applies to all those collecting, transmitting, storing, or analyzing personal medical records, including health care providers, insurance companies, benefit consultants, drugstore chains, and employers. Privacy protections would be extended to privately funded research as well. NASW will work to ensure that any new legislation recognizes the privacy of medical records and includes psychotherapy records. Legislation should include the following tenets:

• Access to records. Patients should have access to all personal health information. Penalties. Criminal and civil penalties should be imposed for unauthorized use of protected health information. Limitations of use. Disclosed information may only be used for the purposes for which it was disclosed and be time limited. High-quality care. Privacy regulations should not impede the quality of care that an individual receives. An appropriate balance between confidentiality and quality must be met and maintained. Viable medical research. Research institutions must abide by new privacy standards and regulations while maintaining viable and effective research programs that continue to contribute to biomedical and behavioral research.
• Enforcement. Once these standards are set in place, legislation must make enforcement provisions to ensure that necessary groups and individuals adhere to the new regulations.

January 2002
NASW Government Relations and Political Action