Monday, July 5, 2010

Mental Health Parity Rules Eased

Mental health parity rules implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAE) apply to qualified health plans in the Patient Protection and Affordable Care Act in same manner as they apply now group health plans, and on July 1 the Employee Benefit Security Administration made it a little bit easier to apply those parity rules

EBSA has provided a temporary safe harbor for outpatient mental health benefit provisions that commonly require a copayment for office visits (for example, physician or psychologist visits) but coinsurance for other outpatient services (for example, outpatient surgery, facility charges for day treatment centers, laboratory charges, or other medical items).

Interim final rules to the MHPAEA state that separate sub-classifications for generalists and specialists generally are not allowed except as permitted for multi-tier prescription drug formularies. The safe harbor extends that sub-classification allowance to office visits and non-office visits.

However, in a July 1 FAQ, EBSA noted that until final rules are issued, an “enforcement safe harbor” will allow a plan or issuer to divide its benefits furnished on an outpatient basis into two sub-classifications for purposes of applying the financial requirement and treatment limitation rules under MHPAEA, as follows:

(1)   office visits, and
(2)   all other outpatient items and services.

According to EBSA, “After the sub-classifications are established, the plan or issuer may not impose any financial requirement or treatment limitation on mental health or substance use disorder benefits in any sub-classification (i.e., office visits or non-office visits) that is more restrictive than the predominant financial requirement or treatment limitation that applies to substantially all medical/surgical benefits in the sub-classification using the methodology set forth in the interim final rules.”

For a comprehensive analysis of the Patient Protection and Affordable Care Act, including the full text of the law and additional information on health reform and other developments in employee benefits, just click here.


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