Widened mental benefits pose test

The new law, which lifts limits on care, adds the four mental health disorders to nine other common psychiatric conditions that health insurers must cover as they do physical ailments. That means, for example, that a drug addict who previously would have been denied treatment after 24 outpatient sessions and a total of 60 days in a hospital will now get as much care as medically needed to tame an addiction.

While patient advocates hailed the expansion of mental health assistance, the people who will pay the bills - insurers and companies that provide health coverage to their workers - greeted the law with uncertainty, especially about its cost.

The expansion illustrates two of the most pressing issues in healthcare today: equality for mental health services and the price tag for expanding medical care.

“Any step we take that breaks down this artificial divide that exists between mental illness and physical health is a big step,’’ said Matt Noyes, a mental health advocate at Health Care for All, a Massachusetts consumer group.

Medical spending is under scrutiny from Beacon Hill to Capitol Hill, and the cost of expanding mental health coverage, known as “mental health parity,’’ is a matter of disagreement.

Supporters of the change, citing the experience of other states, said they expect parity will add less than 1 percent to overall healthcare costs, while easing the stigma of mental illness.

Insurers’ overall spending in Massachusetts, estimated at about $13 billion a year, will increase by $13 million to $39 million a year because of the new law, according to regulators’ calculations.

But a coalition of employer and insurance groups contends that the costs are likely to be significantly higher. Insurers said that the state’s calculations substantially underestimate the costs. They have not, however, come up with their own estimates.

“We will be able to tell in about two years from actual experience,’’ said Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans, a trade group. “Everything else is an estimate based on what we think will happen. Reality is sometimes different.’’

Employers, also anxious about healthcare costs, say they, too, have not yet calculated how the new law will affect their tight budgets.

“Hopefully, it gets people the care they need, but is also cost-effective,’’ said Jim Klocke, vice president of the Greater Boston Chamber of Commerce. “We have had a cost problem in this state for a while.’’

Last summer, the Chamber of Commerce joined a coalition of business groups that lobbied lawmakers against passage of a more sweeping mental health parity law, which would have required equal coverage for an even broader range of conditions.

Not even the new law will ensure that every person in the state who needs those services will get them. Roughly half of Massachusetts companies are exempt from state insurance laws, meaning that they are governed by federal regulations that call for less-generous mental health services.

A new federal mental health law aimed at closing many of the gaps between state and national rules does not kick in for most of these companies until January, and, even then, the rules exempt some of them.

Ron Bachman, a former principal at PricewaterhouseCoopers who is now a healthcare consultant in Atlanta, calculates that at least 31,000 Massachusetts residents will fall into this enduring loophole.

“Should the advocates be anxious and careful and watchful? Sure,’’ he said. “There will be companies out there that try and find the loopholes. But at the end of the day, the vast majority of people will get improved mental health benefits.’’

There remains one piece of unfinished business. When the state last attempted to overhaul mental health services nine years ago, regulators left untouched the broad range of treatment that falls somewhere between overnight hospital stays and trips to the psychiatrist. That includes such services as residential treatment programs, home-based care, and day treatment programs. In that void, advocates say, patients have often had to battle, frequently failing, to get needed help.

“People with mental illness often have more difficulty navigating the speed bumps that health plans put in place,’’ said Dr. Gregory Harris, a Brookline psychiatrist and chairman of the managed-care committee of the Massachusetts Psychiatric Society.

State Insurance Commissioner Nonnie S. Burnes, who has been meeting for months with leaders from all sides of the issue, said she hopes to issue clear guidelines by the end of summer.

“We are working hard with the Department of Mental Health, as well as insurers and providers,’’ she said, “. . . so the consumers of Massachusetts will get what they are entitled to.’’

Kay Lazar can be reached at klazar@globe.com.