New Mental Health Parity Law February 9, 2010Posted by Crazy Mermaid in Healthcare, mental illness, NAMI.
Tags: Healthcare, mental illness, NAMI
Sunday’s Wall Street Journal article by Jillian Mincer, Mental-Health Benefits, heralded the new Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which took effect January 1, 2010. Paul Wellstone, Democratic Senator from Minnesota, and Pete Domenici, Republican Senator from New Mexico, formed an unlikely bond through their personal family stories of mental illness, coming together to ultimately pass a new law designed to make the world a better place for people suffering from mental illness.
The forerunner of this new act, The Mental Health Parity Act of 1996 (MHPA), was the first such effort. Basically, it said that a group health plan couldn’t impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical surgical benefits. This act was necessary because it was common practice for insurance companies to pay more for medical illnesses than mental illnesses.
For example, if Harry required open-heart surgery, an insurance company limited the amount of money it would pay a provider to $2 million over the course of Harry’s lifetime for his heart. That same insurance company would turn around and limit the amount of money it would pay a provider for Tom’s depression to $750,000 over the course of his lifetime. The MHPA of 1996 mandated that if the insurance company allowed Harry $2 million in insurance for his heart, then Tom got $2 million for his mental health treatment. But that law didn’t go far enough. The insurance industry still managed to heap tons of discrimination on the treatment of mentally ill patients. So we went to work, cutting away some of the insurance industry’s wiggle room. The result was the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 went into effect in October 2009. But the new coverage wasn’t available until only a little over a month ago (January 1, 2010), which is when new insurance policies went into effect.
The MHPAEA still allows companies to decide whether to offer mental health and substance abuse disorder (MH/SUD) benefits in their benefits package. They don’t automatically have to offer them when they offer medical health policies. So that means that the only groups that are affected by the new law are those that already have mental health and substance use disorder (MH/SUD) benefits in their benefit packages and choose to retain those benefits.
Key changes made by MHPAEA, which is generally effective for plan years beginning after October 3, 2009, include the following:
• If a group health plan includes medical/surgical benefits and mental health benefits, the financial requirements (e.g., deductibles and co-payments) and treatment limitations (e.g., number of visits or days of coverage) that apply to mental health benefits must be no more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits;
• If a group health plan includes medical/surgical benefits and substance use disorder benefits, the financial requirements and treatment limitations that apply to substance use disorder benefits must be no more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits;
• MH/SUD benefits may not be subject to any separate cost sharing requirements or treatment limitations that only apply to such benefits;
• If a group health plan includes medical/surgical benefits and mental health benefits, and the plan provides for out of network medical/surgical benefits, it must provide for out of network mental health benefits;
• If a group health plan includes medical/surgical benefits and substance use disorder benefits, and the plan provides for out of network medical/surgical benefits, it must provide for out of network substance use disorder benefits;
• Standards for medical necessity determinations and reasons for any denial of benefits relating to MH/SUD, must be disclosed upon request;
• The MHPA parity requirements under existing law (regarding annual and lifetime dollar limits) continue and are extended to substance use disorder benefits.
While these new requirements are getting us all closer to a more just mental health system, we still have a long way to go.
Note: Check out Time Inc.’s interview with Senator Pete Domenici. Senator Donenici, whose daughter suffers from schizophrenia, worked closely with National Alliance on Mental Illness (NAMI) in order to get his bill passed into law. A fascinating read. http://www.time.com/time/nation/article/0,8599,1848887,00.html.