MEMBER UPDATE: Mental Health Parity
The Wellstone-Domenici Parity Act went into effect on January 1, 2010. Insurance companies must comply with the law on that date even though federal regulations that clarify what the law intends had not been published. The Interim Final Rule/regulations (IFR) were issued February 2010 and generally apply to group health plans and group health insurance issuers for plan years beginning on or after July 1, 2010.
Visit www.mentalhealthparitywatch.org for detailed information
APA's Summary of Final Comments to the IFR. To read APA's comment letter in its entirety click here. [posted 5.3.2010]
Press Release [posted 4.1.2010]: The Parity Implementation Coalition, of which APA is a member, released a new legal analaysis of MHPAEA regulations. The Patton Boggs analysis found that health plans must offer a range and scope of addiction/mental health services on part with medical services, but can apply equitable cost containment.
Mental Health Parity - Status Update & Review. (PowerPoint presentation from the February 23rd OHSF Webinar.) The Webinar discussed the status of parity implementation; reviewed key parity statute provisions and the IFR (Interim Final Rule); explained key terms; discussed application of the regulations, and outlined reporting, compliance and enforcement. There is no audio available.
The following memo was sent to the APA's DB/SA executive directors on October 22nd. It provides an overview of the federal parity law, reports on the status of the implementation of the law as of October 2009, identifies potential changes in coverage that may affect the practice of psychiatry, and requests feedback on already-identified issues related to the law.
Date: October 22, 2009
To: District Branch/State Association Executive Directors
Re: Federal Parity Law Implementation
The purpose of this memo is to update you on the status of the implementation of the federal parity law and to ask for your feedback on issues related to the law that you have identified.
The Wellstone-Domenici Parity Act (the Act), which became law on October 3, 2008, goes into effect on January 1, 2010. Generally, the law requires that any group health plan that covers more than fifty employees and offers mental health and/or substance use disorders coverage must provide that coverage with no greater financial requirements (i.e., co-pays, deductibles, annual or life-time dollar limits) or treatment limitations (i.e., number of visits) than the predominant requirements that it applies to substantially all medical/surgical benefits. There is some ambiguity about what the terms predominant and substantially all will mean in implementation. Also, it is unclear if certain insurance company practices, such as prior authorization and other utilization management tools, are considered treatment limitations and therefore subject to the requirements of the law. Further, we do not know if plans will be allowed to maintain “separate but equal” deductibles for mental health and substance abuse coverage. Many states already have mental health insurance or parity laws in place and there is also some ambiguity about which law takes precedence (state or federal), although the law that is most protective of consumers’ access to care is meant to preside.
Federal guidance and regulations that clarify what the law intends are usually issued before a law like this goes into effect and, in this case, the statute required that regulations be issued by October 3, 2009. Unfortunately, the Departments did not meet that deadline and they have informed Congress that they expect to issue the regulations by January of 2010. However, the law still goes into effect on January 1, 2010 and insurers must comply with the law on that date. We have heard that insurers have already been making changes for 2010 plans based on what they believe the law requires and permits.
The APA has been talking to health plans and large insurers since the bill became law in an attempt to determine any changes in coverage that may result and what the bill will mean for the practice of psychiatry. The problem, as stated above, is that no one is currently entirely sure of what the law requires even though plans must already have their coverage standards in place for 2010, and compliance is expected on January 1.
Numerous insurers and employers have begun announcing new coverage requirements for 2010, which we view as inconsistent with the law. For example, recently Blue Cross/Blue Shield (BC/BS) has presented its psychiatrist providers in Florida and Illinois with new, and onerous, prior authorization requirements for psychiatric care for 2010, which were prompted by the implementation of the Act. The Florida and Illinois District Branches, with the assistance of the APA’s Office of Healthcare Systems and Financing (OHSF), have begun negotiations with BC/BS to try to mitigate these requirements since the APA believes they are in conflict with the intention of the law.
It is vital that we know what’s happening on the ground if we are to be able to provide any assistance and we ask that you contact the APA if you have been notified of any other changes in coverage policy for 2010. If you have heard from any insurers about changes in their policies for 2010 that seem to have resulted from the Parity Act, please contact the APA’s Managed Care HelpLine at 800-343-4671 or hsf@psych.org. In addition, you may directly contact either Irvin “Sam” Muszynski, JD,OHSF Director (IMuszynski@psych.org) or Jennifer Tassler, JD, Deputy Director of Regulatory Affairs, Department of Government Relations (JTassler@psych.org).