Mental health benefits and medical health benefits need to be made available on an equal basis, according to Congress. The idea was to prevent employers from being more generous with health benefits for standard medical and surgical services than they were for mental health and addiction services.

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New Guidelines for Mental
Health Benefits

2. Mental health benefits and medical health benefits need to be made
available on an equal basis, according to Congress. The idea was to prevent
employers from being more generous with health benefits for standard
medical and surgical services than they were for mental health and addiction
services.
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This is why Congress passed the Mental Health Parity
and Addiction Equity Act of 2008. To measure the
equality of the two types of benefits, they added
criteria such as co-pays, deductibles, maximum days of
treatment or access to high quality, non-local "centers
of excellence.“
Since 2008 when Congress originally passed this law, the federal
government issued interim regulations with the goal of making adherence
and enforcement easier. Now, after sifting through about 5,400 public
comments, federal agencies issued final regulations on November 8th. The
Labor Department, Treasury Department and Health and Human Services
combined to clarify some ambiguous issues and tightened up others

3. What You Need to Know
First, the new regulations apply both to group benefit plans and individual
policies. If you are self-insured, you will face somewhat similar
requirements under the Affordable Care Act (ACA), as will insurers
offering policies through the public exchanges.
The ACA's "minimum essential benefits" include mental health and
substance abuse services. This applies to plans which are available
through public exchanges. As you already know, if an employer has at
least one employee who seeks and receives a tax subsidy by buying
insurance through a public exchange, that employer is subject to a
substantial excise tax (beginning in 2015). However, this only applies,
when the employer either doesn't offer health coverage at all, or offers
coverage that flunks the ACA's affordability or minimum value standards.
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4. Distinction Drawn on Benefit Caps
The ACA prevents employers from placing annual or lifetime caps on
health benefits and additional treatment. But the Mental Health Parity
Act doesn't prevent caps, as long as such limits pertain equally to other
health benefits. So mental health and substance abuse services which are
covered under the ACA are not subject to annual or lifetime caps. Such
services which are not covered under ACA may have limits.
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5. Technically the Mental Health Parity Act doesn't apply to employers with
50 or fewer employees. The same is true for the ACA and some other
federal labor laws. Yet smaller employers (other than, perhaps, the
smallest of the small) often decide it's wiser to act as if they are subject to
the law. Why? Reasons include state laws, labor market competition, and
an expectation that they may soon exceed the 50-employee threshold.
The new elements in the final mental health regulations take effect for
plan years beginning on or after July 1, 2014. So if your benefit plan's
annual cycle coincides with the calendar year, you won't need to comply
until Jan. 1, 2015. But that's no reason to forget about it for now. Instead,
it's a good opportunity for a refresher course on what was required under
the 2010 rules.
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6. New "Consumer Protections"
Here is the government's official summary of key changes under the new
final regulations (from the November 8 announcement). Examples of new
"consumer protections" include:
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• Ensuring parity applies to intermediate levels of care received in
residential treatment or intensive outpatient settings;
• Clarifying the scope of the transparency health plans must adhere to.
This includes disclosure rights of plan participants, to ensure
compliance with the law;
• Clarifying that parity applies to all plan standards, including
geographic limits, facility-type limits and network adequacy; and
• Eliminating a provision which lets insurance companies avoid the
parity requirements for some benefits based on "clinically
appropriate standards of care." Clinical experts advised this was
confusing and open to potential abuse.

7. The regs put elements of health care and mental health care into six
categories. This allows for greater comparability between the two types
of care, and makes it easier to ensure compliance. The categories are:
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1. Inpatient in-network
2. Inpatient out-of-network
3. Outpatient in-network
4. Outpatient out-of-network
5. Emergency care, and
6. Prescription drugs
The final regulations make it clear, mental health benefits must fit into
one of these categories. It is not acceptable to create a new category.

8. Parity for "Qualitative" Benefits
The final regulations also spelled out how mental health benefits must be
equal to health care benefits, based on qualitative factors. An example
would be looking at the hoops employees have to jump through to get
authorized treatment.
Finally, the new regulations include several disclosure requirements. For
example, a health plan must spell out the criteria used to determine
whether mental health and substance abuse treatment is needed,
therefore covered. Similarly, when reimbursement for treatment in this
area is denied, plans must explain the reasons for the denial.
A user-friendly rundown on how to comply with the Mental Health Parity
Act and how it intersects with the ACA can be found on this Department
of Labor Q&A web page.
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10. 14550 Torrey Chase Blvd., Ste. 360 Houston, TX 77014 USA
www.hrp.net
E-mail : info@hrp.net
Toll Free
Phone
Fax
:
:
:
877.880.4477
281.880.6525
281.866.9426