Mental Health Parity

Training Available on Mental Health Parity Implementation

Attention behavioral health leaders: The National Association of Psychiatric Health Systems (NAPHS) is offering on CD a four-hour training in which leading analysts and experts explain the new regulations as well as their implications for the marketplace and for consumers. More information and a downloadable PDF of the order form are available here.

Posted August 25, 2010

 

Share Your Experience with Mental Health Parity


Both the National Alliance on Mental Illness and American Psychiatric Association have created websites to gather information on the implementation of the mental health parity law and regulations. If you have a story to share, please visit the websites of either the APA or NAMI or call (866) 882-6227 to report concerns.

Posted March 24, 2010



Federal Agencies Release Interim Final Rule to Implement Wellstone-Domenici Act

On February 2,
 2010, the departments of Health and Human Services, Labor, and the Treasury issued interim final regulations to interpret the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act.

Last year, the Mental Health Liaison Group (of which CHADD is a member) submitted comments in a letter cosigned by 44 member organizations. The letter urged the agencies to interpret the legislation in the most consumer-favorable manner allowable. The interim final rules (IFR) ban health plans from imposing separate deductibles or setting separate out-of-pocket caps for mental health and medical/surgical services. And, the concept of “non-quantitative limits” in the IFR suggests that managed care policies for mental health services may be no more restrictive than those used on medical/surgical services.

The National Council for Community Behavioral Healthcare has issued the following brief summary of the provisions of major interest to mental health advocates.

Effective Date: This IFR goes into effect on April 5, 2010 and applies to insurance plans with plan years starting on July 1 or later.

Plans that Must Comply with the IFR: The IFR applies to group insurance plans of 50 or more people. Although the law also applies to Medicaid managed care plans, these plans are NOT included in the IFR. Additional guidance on how parity will apply to Medicaid managed care will be released by the Department of Health and Human Services in the future.

Scope of Service: The IFR divides benefits into six classifications:

1. Inpatient, in-network
2. Inpatient, out-of-network
3. Outpatient, in-network
4. Outpatient, out-of-network
5. Emergency care
6. Prescription drugs

Within each classification, if a plan provides mental health or substance use benefits, those benefits must be provided at parity with the medical/surgical benefits provided in that classification.

In addition, the Departments are encouraging public comments on whether and to what extent the Parity Act addresses scope of services or continuum of care provided by insurance plans (information about how to submit public comments is included in the IFR).

Medical Management: The IFR distinguishes between two types of limits on services: "quantitative limits" (for example, limits on dollar amounts or number of sessions), and "non-quantitative limits." The IFR expressly prohibits plans from making use of the following non-quantitative limits, unless similar restrictions exist for medical/surgical benefits: medical management, prescription formulary design, "fail-first" or step therapies, and prior authorization.

Cumulative Financial Requirements: The IFR prohibits plans from instituting separate deductibles, copayments, and out-of-pocket limits for MH/SU and medical/surgical benefits. Any deductibles, copayments, and out-of-pocket limits required by the plan must be integrated and cumulative for all services.

Exemptions: The statute allows for health insurance plans to be granted a 1-year exemption from the parity requirements if they experience total increased costs of 2% in the first year after implementation and 1% in subsequent years. The criteria for this exemption are not included in this IFR. They will be released in the future.

Updated February 2, 2009
Page updated June 28, 2012