Federal agencies are using temporary regulations to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.
An older parity act, the Mental Health Parity Act of 1996, has required plans that offer mental health benefits to use the same total lifetime and annual benefits limits for mental health care and general medical care.
The MHPAEA goes further. The new act will prohibit employer-sponsored health plans with more than 50 participants that offer mental health benefits from "applying any financial requirement or treatment limitation to mental health or substance abuse disorder benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation applied to substantially all medical/surgical benefits in the same classification." Deductibles, co-payments and other plan features may be no more restrictive for mental health care than for other types of care.
The Internal Revenue Service, the Employee Benefits Security Administration (EBSA) and the Centers for Medicare and Medicaid Services (CMS) published a joint request for information about ideas for implementing the act about a year ago, and they announced in interim final rules released in January that the rules would take effect July 1. EBSA alone has received more than 5,000 comments on the interim rules.
If federal agencies stick with the current schedule, employers with plan years that match the calendar year will have to start incorporating the rules in their plans Jan. 1, 2011.
The federal agencies say they have to use interim rules to implement MHPAEA provisions to comply with the statutory deadlines built into the act.
Many of the carriers and behavioral care managers responsible for implementing the rules asked the agencies for more time.
"The implementation of a new and comprehensive regulation in such a timeframe is a difficult proposition at best," Dawn Owens, the chief executive officer of the OptumHealth division at UnitedHealth Group Inc., Minnetonka, Minn., has written in a comment sent to CMS. The federal agencies have not left enough time to fix interim rules problems that could lead to big increases in employers' bills and patients' out-of-pocket costs, Owens says.
Some plans, for example, now offer a lower deductible for access to mental health services; the new rules probably will force those plans to increase the mental health care deductible to the level of the general medical care deductible, Owens says.
John Littel, an executive vice president at Amerigroup Corp., Virginia Beach, Va., a company that runs government health plans, such as Medicaid plans, says CMS officials have been responsive to Amerigroup, given the enormous workload they face. He says how agencies go about applying the new MHPAEA rules could shed light on how they will implement the new federal Affordable Care Act (ACA) health reform rules.
