Mental Health and Substance Abuse Parity Law Implemented

 

As reported in the November 2009 MGH Community News (“ Federal Mental Health Parity Law in Effect in January”), thePaul Wellstone, Pete Domenici Parity Act, passed in 2008, becomes effective in 2010. On January 29, 2010, the US Departments of Health and Human Services, Treasury and Labor released interim regulations providing guidance on how the Act must be implemented. The interim regulations go into effect on April 5, 2010 and apply to group insurance plans with plan years starting on July 1, 2010 or later. The interim regulations apply to group insurance plans of 50 or more people. Although the Wellstone-Domenici law also applies to Medicaid managed care plans, these plans are not included in the interim regulations.

The new rules prohibit group health insurance plans—typically offered by employers—from restricting access to care by limiting benefits and requiring higher patient costs than those that apply to general medical or surgical benefits. The new law requires that any group health plan that includes mental health and substance use disorder benefits along with standard medical and surgical coverage must treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review.  These practices must be based on the same level of scientific evidence used by the insurer for medical and surgical benefits.  For example, a plan may not apply separate deductibles for treatment related to mental health or substance use disorders and medical or surgical benefits—they must be calculated as one limit. The law applies to employers with 50 or more workers whose group health plan chooses to offer mental health or substance use disorder benefits.

Public Comment Period

Comments on the interim final regulations are still being solicited and are due 90 days after the publication date.  Sections where further comments are being specifically sought include so-called “non quantitative” treatment limits such as those that pertain to the scope and duration of covered benefits, how covered drugs are determined (formularies), and the coverage of step-therapies.  Comments are also being specifically requested on the regulation’s section on “scope of benefits” or continuum of care.

Comments may be emailed to the federal rulemaking portal at: http://www.regulations.gov/ .   Comments directed to HHS should include the file code CMS-4140-IFC.  Comments to the Department of Labor should be identified by RIN 1210-AB30.  Comments to the Treasury’s Internal Revenue Service should be identified by REG-120692-09.  Comments may be sent to any of the three departments and will be shared with the other departments.  Please do not submit duplicates.

-From: “Interim Regulations announced for the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008”, Faces and Voices of Recovery; Organizing the Recovery Movement, at http://www.facesandvoicesofrecovery.org/about/campaigns/equity.php,retrieved 2/23/10, and “Obama Administration Issues Rules Requiring Parity in Treatment of Mental, Substance Use Disorders”, News Release, January 29, 2010 at http://www.hhs.gov/news/press/2010pres/01/20100129a.html retrieved 2/23/10.

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