Mental Health Parity Rules Prohibit Separate Deductibles
| Date Posted: February 4, 2010 |
Group health plans may not impose separate deductibles for mental health and medical coverage, under federal rules issued Feb. 2 (75 Fed. Reg. 5410) to implement the mental health parity expansion law Congress enacted in 2008.
The interim final rules from the three HIPAA portability agencies detail how plans must be designed to comply with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which greatly expanded the 1996 Mental Health Parity Act's requirements and extended them to "substance use disorder" benefits as well as mental health benefits.
Despite concerns about the "cost of converting systems to permit unified deductibles," the U.S. Departments of Labor, the Treasury and Health and Human Services decided "that prohibiting separately accumulating financial restrictions and quantitative treatment limitations is more consistent with the policy goals that led to the enactment of MHPAEA," according to the preamble.
MHPAEA does not actually require group health plans to offer mental health benefits. But for plans that do, "financial requirements" and "treatment limitations" for mental health and substance use disorder benefits may not be more restrictive than the "predominant" such provisions for medical and surgical benefits.
The new rules define or quantify terms like "predominant" and subdivide benefits into six categories for purposes of comparison — inpatient vs. outpatient and in-network vs. out-of-network, with separate categories for emergency care and prescription drugs. So for example, coverage of in-patient, in-network mental health care must not be more restricted than coverage of in-patient, in-network medical care.
Notably, the rules do not differentiate primary and specialty care for this purpose, meaning plans may no longer both impose higher copayments for specialty care and classify most mental health care providers as specialists.
The MHPAEA law itself is taking effect for plan years beginning on or after Oct. 3, 2009, and the rules will take effect for plan years beginning on or after July 1, 2010. For the period between these two dates — during 2010, for calendar-year plans — "the Departments will take into account good-faith efforts to comply with a reasonable interpretation of the statutory MHPAEA requirements," according to the preamble.
A detailed discussion of the new MHPAEA rules and their implications for plan sponsors will appear in the Employer's Guide to HIPAA.
The interim final rules from the three HIPAA portability agencies detail how plans must be designed to comply with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which greatly expanded the 1996 Mental Health Parity Act's requirements and extended them to "substance use disorder" benefits as well as mental health benefits.
Despite concerns about the "cost of converting systems to permit unified deductibles," the U.S. Departments of Labor, the Treasury and Health and Human Services decided "that prohibiting separately accumulating financial restrictions and quantitative treatment limitations is more consistent with the policy goals that led to the enactment of MHPAEA," according to the preamble.
MHPAEA does not actually require group health plans to offer mental health benefits. But for plans that do, "financial requirements" and "treatment limitations" for mental health and substance use disorder benefits may not be more restrictive than the "predominant" such provisions for medical and surgical benefits.
The new rules define or quantify terms like "predominant" and subdivide benefits into six categories for purposes of comparison — inpatient vs. outpatient and in-network vs. out-of-network, with separate categories for emergency care and prescription drugs. So for example, coverage of in-patient, in-network mental health care must not be more restricted than coverage of in-patient, in-network medical care.
Notably, the rules do not differentiate primary and specialty care for this purpose, meaning plans may no longer both impose higher copayments for specialty care and classify most mental health care providers as specialists.
The MHPAEA law itself is taking effect for plan years beginning on or after Oct. 3, 2009, and the rules will take effect for plan years beginning on or after July 1, 2010. For the period between these two dates — during 2010, for calendar-year plans — "the Departments will take into account good-faith efforts to comply with a reasonable interpretation of the statutory MHPAEA requirements," according to the preamble.
A detailed discussion of the new MHPAEA rules and their implications for plan sponsors will appear in the Employer's Guide to HIPAA.
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