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Eployer Benfits at Carolina Behavioral Health Alliance

Is Your Health Plan Prepared to Implement the
New Mental Health Parity Act?

On October 3, 2008, President Bush signed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act that will end health insurance benefits inequity between mental health/substance use disorders and medical/surgical benefits for group health plans with more than 50 employees.  The Act will apply to plans beginning in the first plan coverage year that is one year from the date of enactment. For most, plans the effective date will be January 1, 2010.

If health plans cover mental health and substance use disorders, the Equity Act requires the following:

  • Financial coverage for mental health and substance used disorder benefits
    cannot be more restrictive than the most common financial requirements applied to medical/surgical benefits under the plan
  • Equity coverage applies to plan deductibles, copayments, coinsurance and
    out-of-pocket expenses.
  • Treatment limitations cannot be more restrictive than treatment limitations applied
    for medical/surgical benefits.  This would require health plans to remove day and
    visit limits on mental health and substance use disorders for inpatient and
    outpatient visits unless these limits are imposed on the medical/surgical benefits.
  • That group health plans and insurers that deny mental health or substance use
    disorder coverage explain the reason for that denial.
  • Extends coverage to out-of-network providers where such out-of-network coverage is available under the plan’s medical/surgical benefits.
  • Group health plans can determine what is covered services in terms of mental
    health and substance use disorders
  • A floor for minimum coverage in states where parity is not at or above the federal
    parity requirements
  • An exemption for employers if the plan can establish that adoption would result in
    a cost increase of more than two percent in the first year and one percent in the
    second year
  • The health plan to disclose to current and potential plan participants and providers
    the plan’s criteria for determining medical necessity
In order to comply with the Mental Health Parity Act, employers will have little time to evaluate and modify their plan documents and assess management strategies. CBHA can assist plans in management strategies, plan definitions and plan design. CBHA’s behavioral health management processes are evidenced based can assure that your health plan’s mental health and substance use benefits of effectively and efficiently managed

 

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