After much debate and most likely gnashing of teeth, The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act is now the law of the land. Do you know the details? How ’bout how it applies to you? Well, just in case, here’s the skinny…
First of all, for most group health plans, the law went into effect January 1, 2010. And the reason I say “most” is because the law technically goes into effect upon the first renewal of a group health plan on or after October 3, 2009.
Here’s the big picture…
The law requires most group health insurance plans to cover treatment for mental health and substance abuse/dependence disorders on the same terms and conditions as medical conditions.
But let’s take a gander at some of the law’s fine print…
- Mandating mental health and substance coverage is not part of the deal
- It only applies to plans offered by companies with 51+ employees
- Federal Employees Health Benefits Program, Medicaid managed care plans, State Children’s Health Insurance Programs, and selected state and local government plans must comply
- Fee-for-service Medicaid, Medicare, individual plans, and plans offered by companies with 50 or fewer employees are excluded
- Plans can define the mental health and substance issues they’ll cover, but state-regulated plans must continue to comply with any state requirements to provide coverage of specific mental health and/or substance use disorders
- Treatment limitations and financial requirements for mental health or substance abuse care can’t be more restrictive than for substantially all other health conditions – we’re talking number of covered inpatient days and outpatient visits, co-pays, deductibles, and maximum out-of-pocket limits
- Companies can file for a one year lift on parity if they can prove compliance led to health insurance costs increasing 2%+ the first year and 1% thereafter
- Out-of-network coverage is not mandated unless the plan provides it for medical issues
- Medical necessity (or lack thereof) denials are still allowed
- Federal law doesn’t preempt stronger state law, but trumps weaker law
So there you have a thumbnail on the brand-spankin’-new federal mental health and subsance abuse/dependence treatment parity law. And just some of the questions become…
- How have you been left out?
- If your plan requires compliance, is it happening?
- What about the exclusions? Are they fair?
- The heck with parity. What about folks who have absolutely nothing in terms of insurance or money?
Well, you know by now…we all need to read your thoughts and feelings. Won’t you comment?