APA supports inclusion of parity requirements in Essential Health Benefits rule

Comment letter requests strict adherence to parity law when evaluating state insurance plans

By Government Relations staff

Jan. 17, 2013—As part of ongoing advocacy related to implementation of health care reform under the Patient Protection and Affordable Care Act (ACA), APA submitted comments to the Centers for Medicare and Medicaid Services (CMS) in support of the proposed rule on standards related to essential health benefits (EHB).

Under ACA, health insurance issuers in the individual and small group (those with fewer than 100 employees) must offer the EHB package beginning Jan. 1, 2014. To satisfy the requirements for EHB, plans must include ten specific categories of services, including mental health and substance use disorder services and behavioral health treatment.

CMS is proposing that in order to satisfy the EHB requirement, mental health and substance use disorder services, including behavioral health treatment services, must be provided in a manner that complies with the requirements under the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The parity law requires full parity coverage of mental health compared to physical health benefits, including day/visit limits, dollar limits, coinsurance, copayments, deductibles, and out-of-pocket maximums; extends parity protection to 82 million more people who would not be protected by state laws; and ensures parity coverage for both in-network and out-of-network services.

ACA extends parity to the individual market by requiring that all benchmark and benchmark-equivalent state Medicaid plans, which have historically been less comprehensive than standard Medicaid coverage but provide benefits comparable to an approved private insurance plan, include the ten categories of EHB and comply with MHPAEA. APA supports CMS’ recommendation that MHPAEA criteria be used to satisfy EHB requirements and has requested that CMS require strict adherence to the federal parity law as one criterion when evaluating states’ benchmark plans.

In the proposed rule, CMS outlines a number of different ways that issuers will fail to meet EHB requirements if their products discriminate between mental health and physical health services. The proposed rule specifically states that benchmark or benchmark-equivalent plans that discriminate on the basis of an individual’s mental condition or against specific populations named in the Affordable Care Act would be prohibited.

APA supports this example used by CMS to ensure that issuers understand that discrimination against those who are in need of mental or behavioral health services will not be allowed under federal law.

The final rule on essential health benefits may be released as early as next month, and we expect that more detail on covering mental health benefits at parity will be part of the rule. We will keep members up-to-date as information becomes available.