January 1, 2010 Brings Mental Health Parity (Something Like Equality)

Posted on 09. Oct, 2009 by Dr. Maheu in CLIPS FROM SHM DISCUSSION FORUMS

Let's get ready – it's almost here – the very long-awaited Wellstone-Domenici Parity Act becomes effective on January 1st, 2010.

Under this new law, 113 million people across the country will have the right to non-discriminatory mental health coverage, including 82 million individuals enrolled in self-funded plans (regulated under ERISA), who cannot be assisted by State parity laws. The law will help bring an end to health insurance benefits inequity between mental health/substance use disorders and medical/surgical benefits for group health plans with more than 50 employees.

What Specifically Does it Do? The new law amends the Mental Health Parity Act of 1996 to require that a group health plan of 50 or more employees (or coverage offered in connection with such a plan)—that provides both medical and surgical benefits and mental health or substance use benefits—to ensure that 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.

Equity coverage will apply to all financial requirements, including deductibles, copayments, coinsurance, and out-of-pocket expenses, and to all treatment limitations, including frequency of treatment, number of visits, days of coverage, or other similar limits.

This new law builds on the current 1996 parity law, which already requires parity coverage for annual and lifetime dollar limits.

Mental health and substance use disorder benefits are defined broadly to mean benefits with respect to services for mental health conditions and substance use disorders, as defined under the terms of the plan and in accordance with applicable Federal and State law.

A plan may not apply separate cost sharing requirements or treatment limitations to mental health and substance use disorder benefits.

If a plan offers two or more benefit packages, the requirements of this Act will be applied separately to each package.

As under the current federal parity law, mental health or substance use benefit coverage is not mandated. However, if a plan offers such coverage, it must be provided at parity in accordance with this Act.

Out-Of-Network Benefits. A group health plan (or coverage) that provides out-of-network coverage for medical/surgical benefits must also provide out-of-network coverage, at parity, for mental health/substance use disorder benefits.

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