mhpaea - Image 1On Friday, November 8th, the Department of Treasury, Department of Labor (DOL) and the Department of Health and Human Services (HHS) issued a press release and held a webinar announcing the 206 page final regulations for implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), commonly known as "MHPAEA" or "Parity".

"Without question, the Parity Law is historically one of the most important pieces of federal legislation ever signed into law and will help reduce the stigma and discrimination that has blocked access to life-saving treatment and recovery for millions of people with alcohol and drug dependence for far too long", said Robert J. Lindsey, President/CEO of NCADD. Mr. Lindsey went on to say that, "Since the law went into effect January 1, 2011, the delay in the issuance of the final regulations has created problems for states and insurers as they work to implement the law. Most important, it has created additional problems for consumers. NCADD is very pleased that the final rules have finally been issued."

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.mhpaea - Image 2Left to Right: Rep. Steny Hoyer (D-MD)- House Majority Leader Rep. Jim Ramstad (R-MN) Rep. Patrick Kennedy (D-RI) Former First Lady Rosalynn Carter Rep. Nancy Pelosi (D-CA) – Speaker of the House Background: Robert J. Lindsey- President/CEO NCADD John Shinholser- NCADD Richmond- McShin Foundation (sunglasses)

According to David Lewis, MD, Chair of the NCADD Medical-Scientific Committee, "Achieving parity for substance use disorders and mental health puts them where they belong-----in the mainstream of health care". Passed and signed into law by President Bush in 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA) represents the culmination of almost 20 years of advocacy work by NCADD and countless other addiction and mental health organizations. Although signed into law in 2008, Interim Final Rules (IFR) were published on February 2, 2010, effective April 5, 2010 and went into effect for all plans January 1, 2011. Parity is a critically important component of the effective implementation of the Patient Protection/Affordable Care Act (PP/ACA).

Along with the release of the Final Regulations, a set of FAQ's were released to help answer some of the most common questions:

"Substance abuse and mental disorders are just that disorders, and parity must be the way of the land - the right way", said NCADD Medical-Scientific Co-Chair, Harris B. Stratyner, PhD.

Although more time will be needed to analyze all of the provisions included in the 206 page rule, thanks to Carol McDaid, Capitol Decisions and The Parity Implementation Coalition, here are some of the key provisions in the final regulations:

Scope of Service:

The final rule clarified the scope of service issue by stating:

  1. Classification of Benefits: The 6 classification of benefits scheme (inpatient in and out-of-network, outpatient in and out-of-network, emergency care, and prescription drugs) was never intended to exclude intermediate levels of care (intensive outpatient, partial hospitalization, residential).
  2. All Classifications Must Meet All Parity Tests: The final rule makes it clear that each classification and sub-classification has to meet all parity tests within each classification. And states that "the classifications and sub-classifications are intended to be comprehensive and cover the complete range of medical/surgical benefits and mental health or substance use disorder benefits offered by health plans and issuers." This language, coupled with the new specific examples around intermediate levels of care, makes it clear that MH/SUD services have to be comparable to the range and types of treatments for medical/surgical within each class.
  3. Intermediate Levels of Service: The final rule does not mandate specific services required to be offered by plans under the 6 classification scheme, but the final rule clarifies that plans must assign intermediate services in the behavioral health area to the same classification as plans or issuers assigned intermediate levels of services for medical/surgical conditions.

Non-Quantitative Treatment Limitations (NQTLs):

Disclosure and Transparency- Medical Necessity:

MHPAEA Enforcement:

State Preemption:

Medicaid Managed Care, CHIP and Alternative Benefit Plans:

Cost Exemption for Plans and Issuers:

Application to the Individual Market:

Non-Federal Governmental Plans:

Multi-Tiered Prescription Drugs