Training Available on Mental Health Parity Implementation
Attention behavioral health leaders: The National
Association of Psychiatric Health Systems (NAPHS) is offering on CD
a four-hour training in which leading analysts and
experts explain the new regulations as well as their implications for
the marketplace and for consumers. More information and a
downloadable PDF of the order form are available here.
Posted August 25, 2010
Share Your Experience with Mental Health Parity
Both the National Alliance on Mental Illness and American Psychiatric
Association have created websites to gather information on the
implementation of the mental health parity law and regulations. If you
have a story to share, please visit the websites of either the APA or NAMI or call (866) 882-6227 to report
concerns.
Posted March 24, 2010
Federal Agencies Release Interim Final Rule to Implement
Wellstone-Domenici Act
On February 2, 2010, the departments of Health and Human Services, Labor, and the
Treasury issued interim final regulations to interpret the Paul
Wellstone and Pete Domenici Mental Health Parity and Addiction Equity
Act.
Last year, the Mental Health Liaison Group (of which CHADD is a member) submitted comments in a letter cosigned by 44 member organizations. The
letter urged the agencies to interpret the legislation in the most
consumer-favorable manner allowable. The interim final rules (IFR) ban
health plans from imposing separate deductibles or setting separate
out-of-pocket caps for mental health and medical/surgical services. And,
the concept of “non-quantitative limits” in the IFR suggests
that managed care policies for mental health services may be no more restrictive than
those used on medical/surgical services.
The departments have issued the
following press release. The federal agencies are taking
public comments on the IFR through May 3, 2010. Instructions for how to
comment are included in the official notice published in the Federal
Register.
The National Council for Community Behavioral Healthcare
has issued the following brief summary of the provisions
of major interest to mental health advocates.
Effective Date: This IFR goes into
effect on April 5, 2010 and applies to insurance plans with plan years
starting on July 1 or later.
Plans that Must Comply with the IFR:
The IFR applies to group insurance plans of 50 or more people. Although
the law also applies to Medicaid managed care plans, these plans are NOT
included in the IFR. Additional guidance on how parity will apply to
Medicaid managed care will be released by the Department of Health and
Human Services in the future.
Scope of Service: The IFR divides
benefits into six classifications:
1. Inpatient, in-network
2. Inpatient, out-of-network
3. Outpatient, in-network
4. Outpatient, out-of-network
5. Emergency care
6. Prescription drugs
Within each classification, if a
plan provides mental health or substance use benefits, those benefits
must be provided at parity with the medical/surgical benefits provided
in that classification.
In addition, the Departments are
encouraging public comments on whether and to what extent the Parity Act
addresses scope of services or continuum of care provided by insurance
plans (information about how to submit public comments is included in
the IFR).
Medical Management: The IFR
distinguishes between two types of limits on services: "quantitative
limits" (for example, limits on dollar amounts or number of sessions),
and "non-quantitative limits." The IFR expressly prohibits plans from
making use of the following non-quantitative limits, unless similar
restrictions exist for medical/surgical benefits: medical management,
prescription formulary design, "fail-first" or step therapies, and prior
authorization.
Cumulative Financial Requirements:
The IFR prohibits plans from instituting separate deductibles,
copayments, and out-of-pocket limits for MH/SU and medical/surgical
benefits. Any deductibles, copayments, and out-of-pocket limits required
by the plan must be integrated and cumulative for all
services.
Exemptions: The statute allows for
health insurance plans to be granted a 1-year exemption from the parity
requirements if they experience total increased costs of 2% in the first
year after implementation and 1% in subsequent years. The criteria for
this exemption are not included in this IFR. They will be released in
the future.
Updated February 2, 2009
President Bush Signs Mental Health Parity into Law
On October 3, 2008, President George W. Bush signed into law the
Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act, about
an hour after the House of Representatives passed the act by a vote of
263-171. Congress joined the parity bill with the Emergency
Economic Stabilization Act, the legislation created to address
the economic crisis. The Senate passed the same version of the act
earlier this week.
This is a huge victory for
people affected by AD/HD and related disorders. CHADD thanks all of our
members who reached out to their elected officials, time and time again,
to let Congress know the importance of ending insurance discrimination
against people with mental illnesses. This is a monumental day for CHADD
members and affiliates. See how your Representative voted here.
The mental health parity legislation signed into law today provides
equity between medical-surgical benefits and mental health and addiction
benefits in healthcare plans that offer mental health coverage. The
bill prohibits health insurance plans sponsored by businesses with fifty
or more employees from imposing day and visit limits or applying
different deductibles, copayments, out-of-network charges and other
financial requirements for mental health treatment. The act builds on
the 1996 Parity Act, which provided limited parity for lifetime and
annual dollar limits.
The text of the Emergency Economic
Stabilization Act can be viewed here. The section on mental health parity is located
on pages 310-344.
Updated October 3, 2008
Scroll down to read previous updates on the mental health parity
legislation and its journey into law.
Senate Passes Mental Health Parity; On to House of
Representatives
On October 2, 2008, the Senate passed the Paul
Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 by a vote of 74-25, as
a part of the Emergency Economic Stabilization
Act, which included the revised Wall Street/Main Street
“bailout,” tax extenders, AMT, and disaster relief. Although
every Senator except Senator Ted Kennedy (D-MA) were present for the
vote, the vote should not be interpreted to indicate a particular
Senator’s position on the mental health parity legislation given
the large number of varying issues that were included in the Emergency
Economic Stabilization Act.
The House of Representatives will now debate the
Senate omnibus bill, titled the Emergency Economic
Stabilization Act, on the floor of the House this
evening, October 2, or early in the afternoon of October 3.
Given the 205-228 vote on September 29 in the House of Representatives
on the first economic “bailout”/recovery bill, its passage
in the House is less secure.
The text of the Emergency Economic Stabilization Act can be
viewed here (the section on mental health parity is
located on pages 310-344).
CONTACT YOUR
REPRESENTATIVE: Use the toll-free Parity Hotline,
1-866-parity4 (1-866-727-4894), to call your U.S.
Representative and Senators. The Parity Hotline reaches the Capitol
switchboard, which can connect you to your members of Congress, or
click here to find the names and phone numbers of
your representatives. Ask to be connected to the Health Legislative
Assistant. If you leave a message, include your name and phone
number.
Message: “I’m calling
to ask that the Representative vote for the Emergency Economic
Stabilization Act that includes needed mental health and addiction
parity legislation.”
Updated October 2, 2008
Senate and House Pass Parity: Final Vote Is Still Needed by
Congress
On Tuesday, September 24, 2008, Congress voted on mental health
parity legislation in both the House of Representatives and Senate. The
legislation will require “equity in the provisions of mental
health and substance-related disorder benefits under group health
plans.”
However, because the House and Senate bills in
which mental health parity is included are different in format,
additional votes will be needed to reconcile the legislation so it can
be sent to the President to sign into law.
The Senate voted on the compromise tax package
that added mental health parity legislation as an amendment to a larger
package of tax-related bills (HR 6049). The amendment was introduced by
Senator Max Baucus (D-MT) and Senator Charles Grassley (R-IA). The
Senate voted in favor of the tax compromise package with a vote of
93-2.
Also, the House of Representatives voted on
mental health parity legislation as a stand-alone bill on the House
floor. The Paul Wellstone and Peter Domenici Mental Health
Parity and Addiction Equity Act of 2008 (HR 6983) was
introduced on Monday by Representative Patrick Kennedy (D-RI), and can
be read here. The House of Representatives voted in favor of the
bill with a vote of 376-47.
CHADD thanks all of its members and affiliates
who made phone calls, wrote letters, and sent emails during the last few
months to try to get this important piece of legislation passed by
Congress.
Updated September 24, 2008
Parity Passes Senate; Awaiting House Vote Later Today
This afternoon, September 23, 2008, the Senate voted on a
compromise tax package that added the Paul
Wellstone and Pete Domenici Mental Health Parity and Addiction Equity
Act of 2008 as an amendment to a larger package of
tax-related bills. The amendment was introduced by Senator Max Baucus
(D-MT) and Senator Charles Grassley (R-IA). The Senate voted in favor of
the larger tax package with a vote of 93-2. The mental health parity legislation will require
“equity in the provisions of mental health and substance-related
disorder benefits under group health plans.”
CHADD thanks all of its members and affiliates
who made phone calls, wrote letters, and sent emails during the last few
months to try to get this important piece of legislation passed by
Congress.
Updated September 23, 2008
Updated Status on Mental Health Parity Legislation
The House of Representatives has decided to delay introducing mental
health parity legislation until after the Senate votes on an amendment that includes mental health parity, which
should take place on Tuesday September 22, 2008 in the late
afternoon. A copy of the Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction Equity Act of 2008 (HR
6983), can be viewed here.
Please call your members of
Congress and urge them to pass mental health parity now! Every phone call to Capitol Hill urging
support of the legislation is needed. Even if you have called many times
before, please make one more call to your Senator/Representative to try
to get this bill to the floor for votes by the House and
Senate.
Use the toll-free Parity Hotline: 1-866-parity4
(1-866-727-4894), which will connect you to the Capitol Switchboard
office or click here to find the name and phone number of your
Senator/Representative.
Message: “I’m calling to
ask that the Senator/Representative urge the congressional leadership to
vote yes and pass mental health and addiction parity legislation before
Congress adjourns.”
Earlier this year, after the
Senate and House had passed their own parity bills, negotiators forged a
historic agreement establishing a comprehensive standard of insurance
coverage that will require group health plans to
equitably cover treatment for mental illness. Time
is running out to win its enactment—and your help is
needed!
Updated September 23, 2008
Status of Mental Health Parity
The following action alert comes from the Health Policy
Committee of the Mental Health Liaison Group, of which CHADD is a
member.
Targets: All members of the House and
Senate.
How You Can Help:
•Over the August recess, CHADD members can request
appointments or other in-person contact with their U.S. Representative
and Senators while they are in their home states to discuss the need for
mental health parity legislation to pass this Congressional session.
•Over the August recess, CHADD members can send a
letter or call their U.S. Representative and Senators. Use the
toll-free Parity Hotline, 1-866-parity4 (1-866-727-4894), to call your
U.S. Representative and Senators. (The Parity Hotline reaches the
Capitol switchboard, which can connect callers to their members of
Congress).
Message: “I’m asking that
the Representative/Senator vote for final passage of historic mental
health and addiction parity legislation. Congress must not adjourn in
September without passing this needed bill.”
Status of Bill: The parity compromise
was still pending when Congress recessed on Aug. 1 until September
8. The policy and language of the House-Senate compromise has been
agreed to, and key committees of jurisdiction are still seeking
provisions to offset the cost of the parity bill. They must agree
on the source of $3.8 billion in offsets (“pay-fors” over 10
years) required under the Budget Act.
The Compromise: When enacted the new
federal parity law will—
Completely end insurance discrimination against mental health and
substance use disorder benefits for over 113 million Americans,
requiring full parity coverage with physical health benefits.
Extend to all aspects of plan coverage, including
day/visit limits, dollar limits, coinsurance, copayments, deductibles
and out-of-pocket maximums.
Preserve strong state parity and consumer protection
laws while extending parity protection to 82 million more people who
cannot be protected by state laws.
Ensure parity coverage for both in-network and
out-of-network services.
Town Meetings: Public appearances by
House and Senate Members over this recess are a great venue for parity
advocates to personally impress on Congress the importance of this
issue. Call the local office of your Member for updated
information about where he or she will be meeting constituents.
Or, all Members may be reached through the Capitol switchboard at
202-224-3121. Take the opportunity to attend and press the above
parity support message on the Member.
Updated 08/06/2008
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