Legislative Update, January 2014

Susan Boritz, MA, LMFT
CTAMFT Legislative Liaison (legislation@ctamft.org)

Mental Health Parity, Affordable Care Act and Access to Treatment

MHPAEA Update
On November 8, 2013, the Obama Administration issued a news release announcing the final regulations/rules for implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA), which was originally enacted in 2008 and implemented under interim rules in July 2010.

By way of background, the purpose of the MHPAEA is to reduce misinformation and stigma about mental illness and addiction, as well as increase access to affordable mental health and addiction services. It’s designed to establish “parity,” or equivalence, between mental health/addiction services and medical/surgical treatment.

Specifically, if a group health plan includes mental health and addiction coverage; out-of-pocket costs, including deductibles, coinsurance and copayments must be the same. If the plan has out-of network benefits for medical/surgical treatment, it must provide equivalent out-of-network benefits for mental health/substance abuse treatment. For a full overview of the MHPAEA, please link here.

MHPAEA Final Regulations/Timing
The final regulations have taken into account research, as well as public input throughout the interim period. These rules prevent most group insurance plans from establishing reduced benefit coverage for mental health and addiction services than other kinds of health care services.

Link here to view the final regulations. Please note these final regulations were effective on January 13, 2014 (except some technical amendments – see rules for details). The mental health parity provisions of these final regulations apply to group health plans and health insurance issuers for plan years (or, in the individual market, policy years) beginning on or after July 1, 2014.

Affordable Care Act Expands on MHPAEA
The Affordable Care Act (ACA) expands on the MHPAEA by considering mental health and substance abuse treatment as one of its 10 essential health benefits categories, thereby requiring that it be included in all health insurance plans sold on the exchanges/marketplace.

In Connecticut, as most Marriage and Family Therapists (MFTs) reading this are no doubt aware, laws governing the sale of commercial insurance are made at the state level and vary considerably from state to state. This is particularly true with respect to mental health and substance abuse benefits.

Connecticut law provides for mandatory coverage for the “diagnosis and treatment of mental or nervous conditions, including alcoholism and drug addiction.” Policies cannot be sold without their inclusion. Information about state health insurance mandates and the ACA essential benefits provisions can be found here.

Despite the fact that Connecticut has among the most progressive laws in the country, Connecticut residents have nevertheless faced roadblocks when they have attempted to access care. In the aftermath of the Sandy Hook shootings, such problems in the system have received considerable attention and criticism. In response, representatives from the insurance industry have teamed up with experts from the UConn Health Center to produce a “Tool Kit” to help consumers navigate the system.

Written in clear and accessible language, the toolkit guides the consumer through the process from contacting his/her insurance company, obtaining pre-authorization, and determining their out-of-pocket expenses. The Behavioral Healthcare Claims Toolkit is available here.

If you have any questions, or would like further information, please contact us at legislation@ctamft.org.

Resources:
• November 8, 2013 News Release Announcing Final Mental Health and Substance Use Disorder Parity Rule

• Mental Health Parity and Addiction Equity Act (MHPAEA)

• MHPAEA Final Regulations/Timing

• ACA 10 Essential Health Benefits

• State Health Insurance Mandates & ACA Essential Benefits Provisions

• Connecticut Insurance Department Behavioral Health Consumer Tool Kit