Six points you need to know about the mental health parity law
By Government Relations
March 31, 2010 — At the 2010 State Leadership Conference (SLC) workshop “Parity in Practice: From Passage to Implementation,” Doug Walter, JD, Counsel for Legislative and Regulatory Affairs in the Practice Directorate Government Relations office, and Ronald Bachman, FSA, MAAA, President and CEO, Healthcare Visions, Inc., educated psychology leaders on implementation of the federal mental health parity law.
Walter’s presentation included these six important Parity Points:
Fundamental parity requirement
The Mental Health Parity and Addiction Equity Act (MHPAEA) requires that a group health plan that provides both medical and surgical benefits and mental health or substance use benefits must ensure that the financial requirements and treatment limitations applicable to mental health/substance use disorder benefits are no more restrictive than those requirements and limitations placed on medical/surgical benefits.
The MHPAEA applies to all health plans effective October 3, 2009.
The Interim Final Rule (IFR)—which provides details for compliance with the law—applies to health plans for plan years beginning after July 1, 2010. For most plans, this means January 1, 2011, but health plans are required to continue “good faith” compliance with MHPAEA before the effective date of the IFR.
American Psychological Association (APA) members who pay the Practice Assessment to the APA Practice Organization can read a summary of the IFR compiled by the Government Relations office.
When a health plan provides out-of-network medical benefits, it must provide out-of-network mental health/substance use disorder benefits, at parity.
No separation of deductibles and out-of-pocket maximums
Separate (even if equal) deductible and out-of-pocket maximums may not be imposed on mental health/substance use disorder benefits.
When it comes to copays, psychologists aren’t specialists
Psychologists and other mental health providers cannot be classified as “specialists” for the purposes of imposing higher copayments or other cost sharing.
Your voice is needed
As insurance companies institute the MHPAEA, psychologists may encounter practices they believe aren’t in keeping with the law. Walter encourages practitioners to bring their issues to state psychological associations that, in turn, are communicating with their state insurance commissioners.
If you have questions, please contact the Practice Directorate’s Office of Government Relations at 800-374-2723 X 5889 or by e-mail.