An Update: The New Parity Law and What it Means for You

By Barbara Griswold, LMFT
(February 27, 2010)

Back in November of 2008, I told readers about the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). Well, it just went into effect, so here’s an update on how your life may change because of it.

FIRST, A REVIEW: WHAT IS THE LAW ABOUT? The MHPAEA requires health plans to provide coverage for mental health and addiction treatment that is equal to (“at parity with”) coverage provided for the treatment of physical illnesses covered by the plan. It strengthens and expands previous parity laws, which were very limited in scope. It is estimated that approximately 1/3 of Americans will now have better coverage. Group health plans with more than 50 employees will no longer be able to impose limits on inpatient days or outpatient mental health visits if no such limit exists for medical visits. These plans won’t be able to require higher deductibles or copayments for mental illness or substance abuse treatment than the plan imposes for medical treatment. In addition, if a plan allows your client to go out of their network of providers for medical care, it must also offer out-of-network coverage for mental.

HOW WILL THINGS CHANGE FOR MY CLIENTS?

For some clients, their deductible may be waived or reduced, and/or the co-payment may be lower, meaning they may be able to see you more frequently – and longer – than they otherwise could have.
They may now also be eligible for unlimited sessions.
Some clients will have out-of-network coverage when they previously did not, or better out-of-network coverage.

THE FINE PRINT?

The MHPAEA does not require a plan to cover specific illnesses, but applies to all diagnoses that a plan covers.
The MHPAEA supersedes state parity regulations if the state regulations are more limited.
Individual plans and businesses with 50 or fewer employees are exempt. EAPs are also expected to be exempt.
The MHPAEA doesn’t require coverage to be “good” – it just needs to be equal to medical. Therefore, a client can still have a high deductible or copay or limitations, if their medical coverage does.
A plan is not required to cover any particular provider license (ex. MFTs or LPCs).

THE MOST CONCERNING CATCH? While large plans that have no limit on medical visits can no longer limit mental health or substance abuse visits, they retain the right to cover only “medically necessary” visits. Therefore, I think we will see plans making more of an attempt to review our treatment according to their criteria for medical necessity. This may involve more preauthorizations and data gathering, sometimes even for out-of-network providers. I don’t think it is a coincidence that Anthem Blue Cross of California announced that many of their plans will now require authorization after the 12th visit. Blue Shield of California recently notified providers in one of their plans (the Federal Employee Program PPO) that they must now must get preauthorization, and – beginning March 22nd – submit an Outpatient Treatment Plan prior to the third visit.

BE POSITIVE! But, before we get too pessimistic about paperwork trends, let’s take a moment to enjoy this. Something truly historic and wonderful came out of Washington! At a time when the lack of progress on health care reform is pretty depressing, it is nice to remember that – not that long ago – our representatives were able to get something pretty important passed.

For more details on parity and how it will affect you, I recommend this helpful article: http://www.apapracticecentral.org/news/2008/wellstone-domenici.aspx.

To get the manual that answers all your insurance questions, click here, or to set up your insurance consultation with Barbara, click here.

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Barbara Griswold, LMFT, is the author of Navigating the Insurance Maze: The Therapist’s Complete Guide to Working with Insurance – And Whether You Should. To purchase the book or other resources for therapists, click here. Contact Barbara at barbgris@aol.com to get answers to your insurance questions.

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