A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Fight Over Mental Health Parity Rules

Fight Over Mental Health Parity Rules

May 20, 2010

This guest post is by Matt Selig, Executive Director of HCFA partner, Health Law Advocates:

A semi-under-the-radar public policy battle is taking place over the writing of the administrative regulations that will implement the 2008 federal Mental Health Parity Law. Health care consumers have a lot at stake and the winners and losers in this fight will be determined within a few weeks.

Generally speaking, the Mental Health Parity and Addiction Equity Act requires group health plans providing mental health coverage to provide such benefits in a manner that is equal to other medical benefits. This historic, consumer-friendly statute was signed into law in October 2008 by then-President George W. Bush (seriously).

The statue became binding on group health plan for plan years beginning after October 3, 2009. However, the more detailed administrative regulations drafted by the Obama Administration (specifically the U.S. Departments of HHS and Labor and the IRS) go into effect July 1, 2010 for health plan years beginning on or after that date. A draft of the regulations was published in February 2010.

As usual, the statutory language of the Act describes the law’s broad protections but the Obama Administration’s draft regulations boldly provide numerous additional specific and vital provisions ensuring fairness in coverage for consumers. One key example is an item in the regulations that forbids health plans from imposing more stringent “medical management standards” relative to mental health and substance benefits than for other benefits. The regulations provide a useful illustration: a health plan may not “require() concurrent review for inpatient, in-network mental health and substance use disorder benefits” if the plan “conducts retrospective review for inpatient, in-network medical surgical benefits” (emphasis added). Many mental health care and substance abuse treatment providers will tell you that it is becoming more and more difficult to get approval for coverage from health plans. The regulations, as drafted now, will do a lot to change that IF the key consumer protection provisions aren’t removed from the regulations before they are finalized in July.

The agencies working to finalize the regulations received thousands of public comments on the draft regulations by the May 3, 2010 deadline. They are reviewing them now and are still being lobbied intensely by interested parties as described in this New York Times article.

The Obama Administration’s draft plan for implementing the Parity Law is enormously helpful for consumers. We’ll find out in July if they’ll stick with it.
-Matt Selig, Health Law Advocates