State Leadership Conference

Even though the 2008 parity act went into effect last fall, psychology is continuing its efforts to ensure that the law works as it was intended, said speakers at a 2010 State Leadership Conference workshop.

“We’re still very much in the beginning stages,” said Ronald E. Bachman, FSA, MAAA president and CEO of Healthcare Visions and a former partner of PricewaterhouseCoopers who has extensive experience in health-care strategy. “We have to be creative to make sure things get done right.”

The passage of the 2008 parity law — formally known as the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act — significantly increased Americans’ access to mental health and substance abuse services. The law builds on the benefits of the Mental Health Parity Act of 1996, which required that annual or lifetime dollar limits on mental health benefits be no lower than medical and surgical benefits offered by group health plans.

The 2008 law expands and clarifies those benefits in a variety of ways, such as by requiring insurers’ mental health and substance abuse treatment benefits to be at least equal to their medical and surgical benefits in deductibles, co-payments, co-insurance, out-of-pocket expenses and other costs.

The new law also requires all treatment limitations be at least the same, including the frequency of treatment, number of visits and days of coverage. The law applies only to group health plans with 51 or more employees that provide both medical/surgical and mental health/substance abuse benefits. (For a summary on the new law’s provisions, go to Summary of the New Parity Law.)

Now the rule that fully implements the law is taking shape, and psychologists need to continue their work to make sure the law fully protects Americans’ access to mental health care. On Feb. 2, the U.S. Departments of Labor, Health and Human Services and the Treasury published the interim final rule for the 2008 parity act. After a 90-day comment period, the rule is expected to become final and will go into effect Jan. 1 for most plans.

So far, the rule looks very good for psychology, said APA’s Doug Walter, JD, legislative and regulatory affairs counsel for the APA Practice Organization. The Obama administration has adopted APAPO’s stance on such key points as ensuring that health plans do not have separate deductibles and out-of-pocket maximums for mental health and substance use benefits — under the rule, all of a patient’s medical, surgical, mental health and substance abuse services will be in the same pool. In addition, APAPO has worked to ensure the rule stipulates that health plans cannot classify psychologists and other mental health professionals as “specalists” for the purposes of imposing higher co-payments or other cost sharing.

“I’m pleased to report that the regulators have provided a very favorable regulation from psychology’s perspective,” said Walter. (Read the full interim rule.)

But, he and Bachman cautioned, psychologists need to be aware so that insurers and others follow the law and the rule correctly.

“Anytime you write any law, it’s messy and it can be interpreted differently,” said Bachman. “Compliance by insurance companies, employers and third-party administrators is the critical next step. Every psychologist out there is the eyes and ears that we need to address areas of noncompliance.”

If a psychologist sees that an insurance company fails to pay for substance abuse services or calls for separate deductibles for medical versus mental health services, he or she should alert APA. “You’re out there, all over the country, and you can tell us what is going on,” said Bachman. “It’s better to address [problems] early on so misinformation doesn’t spread.”

In the meantime, APAPO will continue its work with regulators. Just how certain standards will apply, and how they will be interpreted, said Bachman, will have to be “fleshed out, even fought over with insurers over several years to come.”

For questions on parity, contact Doug Walter by e-mail.