Have Policy Changes Due to Parity Had an Impact on Your Practice?

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (PL 110-343), 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 50 employees and offers mental health and/or substance use disorders coverage must provide that coverage with no greater financial requirements (that is, copays, deductibles, and annual or lifetime dollar limits) or treatment limitations (that is, 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 mean and whether such significant practices as requiring prior authorization and applying other utilization management tools are considered treatment limitations and subject to the requirements of the law. It is also unclear whether there can be a separate but equal deductible requirement for mental health and substance abuse coverage—that is, a deductible that is separate from the one for medical/surgical benefits.

Also, many states already have mental health insurance mandates or parity laws in place, and there is some ambiguity about whether the state or federal law takes precedence. The law that is meant to take precedence, however, is the one most protective of consumers' access to care.

Federal guidance and regulations that clarify the terms and intent of a law are usually issued before the law goes into effect. In this case, the regulations for the new parity law are being written by staff from the three cabinet departments that oversee it: the departments of Labor, Health and Human Services, and Treasury. It had been projected that the regulations would be released by October 3, but that deadline was missed. They are now expected in January 2010, even though insurers have already been making changes for 2010 plans based on what they believe the law requires and permits.

APA's Office of Healthcare Systems and Financing (OHSF) has been talking to officials of health plans and large insurers in an attempt to determine any changes in coverage that may result from the law and what the law will mean for the practice of psychiatry in the short run.

Numerous insurers and employers have begun announcing new coverage requirements for 2010, many of which OHSF staff think are onerous and in conflict with the intent of the law.

For example, recently Blue Cross/Blue Shield has presented its psychiatrist providers in Florida and Illinois with new prior-authorization requirements for psychiatric care for 2010. The Florida and Illinois district branches, with the assistance of the OHSF staff, have begun negotiations with BC/BS to try to mitigate these requirements.

Irvin “Sam” Muszynski, J.D., director of OHSF, asks that you contact APA with any information about changes in policy coverage for 2010 that you believe have resulted from implementation of the parity law and that will impact negatively on patient care or your practice.

“It's vital that we know what's happening on the ground if we are to be able to provide any assistance,” said Muszynski.

APA's Managed Care HelpLine can be reached at (800) 343-4671 or at [email protected].