Dear Readers,

It’s hard to believe that it has been nearly a year since the historic passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). We are quickly approaching the Oct. 3 date by which the federal government must issue its parity regulations, so let’s take a look at what is happening.

Three government agencies are responsible for drafting and implementing the law—the U.S. Department of Labor, the Department of Health and Human Services and the Department of Treasury. As we know, MHPAEA consolidated longstanding efforts at the national and state level to establish parity between the financial health coverage for mental health/substance abuse conditions and physical health disorders. These agencies requested comments on several aspects of the proposed guidance in an April 28 Federal Register notice (74 Fed. Reg.19155). Specifically, the agencies were seeking information and advice on the following critical issues:
• How insurance plans currently apply financial requirements and/or treatment limitations to medical and surgical benefits and mental health and substance use disorder benefits—whether these requirements or limitations applied differently to both classes of benefits; and if plans currently vary coverage levels within each class of benefits.
• What terms or provisions require additional clarification to facilitate compliance, and what specific clarifications would be helpful?
• What information, if any, regarding the criteria for medical necessity determinations made under the plan (or coverage) with respect to mental health or substance use disorder benefits is currently made available by the plan? To whom is this information currently made available and how is it made available? Are there industry standards or best practices with respect to this information and communication of this information?
• What information, if any, regarding the reasons for any denial under the plan (or coverage) of reimbursement or payment for services with respect to mental health or substance use disorder benefits is currently made available by the plan? To whom is this information currently made available and how is it made available? Are there industry standards or best practices with respect to this information and communication of this information?
• To gather more information on the scope of out-of-network coverage, the Departments are interested in ­finding out whether plans currently provide out-of-network coverage for mental health and substance use disorder benefits. If so, how is such coverage the same as or different than out-of-network coverage provided for medi­cal and surgical benefits?
• Which aspects of the increased cost exemption, if any, require additional guidance? Would model notices be helpful to facilitate disclosure to Federal agencies, State agencies, and participants and beneficiaries regarding a plan’s or issuer’s election to implement the cost exemption?

More than 400 groups, governments and individuals provided input to the agencies during the public comment period which ended May 29. Many comments expressed concern that managed care tactics would result in more restrictive coverage for addictions and mental health illnesses, such as higher co-pays and limits or exclusion of coverage for certain conditions, treatments, providers or medications.

In a July 27 letter to the respective secretaries of the agencies tasked with issuing the MHPAEA, Senators Edward Kennedy (D- Mass.), Al Franken (D-Minn.), Jack Reed (D-R.I.) and Sheldon Whitehouse (D-R.I.) urged the secretaries to promulgate these regulations in a timely manner, and to not only follow Congressional intent, but also to address concerns raised during the comment period.

“Without timely issuance of regulations that clarify Congressional intent, it is likely that health plans will implement the law according to their proposed version of regulations as set forth in their public comments,” the July 27 letter states. “Only with regulations can we ensure the end to discrimination against those with mental health and substance use disorders.”

The effective date for MHPAEA is the beginning of the plan year one year after the enactment of the law, which means the effective date for most insurance plans will be Jan. 1, 2010.
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Sincerely,

Stephanie L. Muller
Editor Counselor,
The Magazine for Addiction Professionals
A Health Communications, Inc. Publication

This article is published in Counselor, The Magazine for Addiction Professionals, October 2009, v.10, n.5, pg.7.

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