Parity Interim Final Regulations Released, 90 Days for Public Comments
By REBECCA A. CLAY
On January 29, 2010, the U.S. Departments of Health and Human Services (HHS), Labor, and the Treasury jointly issued interim final rules that will govern how group health plans and group health insurance issuers will put into practice the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
Published in the February 2 issue of the Federal Register, the rules go into effect April 5, 2010.
As interim final rules, the regulations are subject to revision. In fact, the Government is actively soliciting input from the public. Comments are due on or before May 3, 2010.
Submit your written comments to any of the addresses below. Please do not submit duplicates.
- HHS: Refer to CMS–4140–IFC By Federal eRulemaking Portal (Follow the instructions under the "More Search Options" tab.) By regular mail: Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services, Attention: CMS–4140–IFC, P.O. Box 8016, Baltimore, MD 21244–1850
- Department of Labor: Refer to RIN 1210–AB30 By Federal eRulemaking Portal (Follow the instructions for submitting comments.) By email: E-OHPSCA.EBSA@dol.gov By regular mail: Office of Health Plan Standards and Compliance Assistance, Employee Benefits Security Administration, Room N–5653, U.S. Department of Labor, 200 Constitution Avenue, NW, Washington, DC 20210, Attention: RIN 1210–AB30
- Internal Revenue Service: Refer to REG–120692–09 By Federal eRulemaking Portal (Follow the instructions for submitting comments.) By regular mail: CC:PA:LPD:PR (REG–120692–09), Room 5205, Internal Revenue
Service, P.O. Box 7604, Ben Franklin Station, Washington, DC 20044
For instructions on hand delivery, overnight mail, or courier service, please refer to the Federal Register document for specific direction.
Consumer groups, professional societies, and others applauded the new regulations.
"Parity regulations are an important milestone on the road to ending the unnecessary suffering for millions of Americans with treatable mental illness and addictions," said Linda Rosenberg, President and Chief Executive Officer of the National Council for Community Behavioral Healthcare. "Now people in need won’t have to go without treatment because of discriminatory insurance policies."
Patients are already benefiting, said Kathleen Nordal, Ph.D., Executive Director for Professional Practice at the American Psychological Association. "Since January 1," she said, "patients have seen copayments and co-insurance for psychological services reduced as mental health treatment is covered at parity with physical health care."
A national advocacy group, Faces & Voices of Recovery, called for further advocacy. "Some insurance companies have already put plans in place that fall short of this law’s intent, severely restricting patients’ access to life-saving care," said Vice Chair Stephen Gumbley. "This needs to change, and we encourage individuals and families covered by these plans to ask them to fully implement policies consistent with this new law."
Officials from the U.S. Departments of Health and Human Services (HHS), Labor (DOL), and Treasury recently held a briefing to explain in more detail the interim final regulations for the Mental Health Parity and Addiction Equity Act (MHPAEA) that apply to employer-sponsored health insurance plans. Officials also answered questions from the media and the field.
All health insurance plans beginning after July 1, 2010, must comply with the MHPAEA regulations, although since most employer plans are calendar-year plans, the full impact will not likely be seen for most plans until January 2011, according to James Mayhew from the Centers for Medicare & Medicaid Services (CMS).
In 2010, health insurance plans are required to make a "reasonable, good faith" interpretation of the statute in their efforts to comply with the new law.
Richard Frank, Ph.D., Deputy Assistant Secretary of the Office of Disability, Aging, and Long-Term Care Policy at the Office of the Assistant Secretary for Planning and Evaluation, delineated some next steps for the officials shaping the parity regulations.
Although MHPAEA regulations provide most of the basic regulatory framework to comply with the law, some issues in the rule will need further clarification. According to Dr. Frank, these include:
- Scope of services/continuum of care
- Medical management and the criteria being used to set medical management policies
- Cost of putting in place unified deductibles
- Provider networks
- The process to be used to determine if an employer qualifies for an exemption to the requirements of the law based upon its cost.
The audience asked and received answers to questions about the regulations. Some issues raised include:
- What is considered a "good faith" interpretation for that period between the effective date of the law and the effective date of the regulations? The regulation writing team responded that compliance would have to demonstrate that the employer made a "reasonable interpretation" to comply with the law.
- What protections apply for mental health services that have no comparable medical/surgical analogue? The regulation writing team noted that they are soliciting additional guidance about this issue.
- What should be done when associations or advocacy groups hear about health insurance plans that are making efforts to side-step the statute? The regulation writing team responded that complaints should be directed to state insurance commissioner for employer insurance plans regulated by the states, to DOL’s Employee Benefit Security Administration for employer plans regulated through Employee Retirement Income Security Act (ERISA), and to CMS for governmental plans.
- How will the Federal law interact with state-level parity and other laws? The regulation writing team indicated that CMS already is working with state insurance commissioners to help clarify this issue, but that the law specifies that state laws that mandate mental health and substance use condition benefits are not preempted by MHPAEA.
These and other questions will be addressed further in the coming months as more research is done on parity and the myriad issues surrounding its implementation.
Watch a webcast of this briefing.
Be sure to submit your comments on the interim final regulations by May 3, 2010.