More Information on Federal Mental Health Parity


Dear Affiliated Society Members,

I've received some questions about the Act which contains mental health and substance abuse parity that I will try to answer here.

Here is what the Act contains.

The Act requires parity between mental health/substance abuse services and medical/surgical services, i.e., if a mental health/substance abuse benefit is offered, it must be at parity with medical surgical benefits in the following areas: 1) co-pays; 2) coinsurance; 3) deductibles; 4) out-of-pocket expenses; and 5) out-of-network coverage.

Here is what the Act does not contain.

First, the Act does not contain a mental health mandate; it contains a mental health offering, meaning that any insurance plan covering large businesses, whether it is a self-insured plan (with Federal oversight) or a state regulated plan, must offer mental health benefits AT PARITY with medical/surgical benefits in
IF mental health benefits are offered. There is no requirement that a mental health benefit or substance abuse benefit be offered. This mainly covers about 82 million enrollees in ERISA plans who had no protection in the plans that were exempt from state parity laws.

Second, there are several major groups that are not included in this Act. They are Medicare (which has a recently mandated mental health co-pay at parity with medical/surgical co-pays which will be phased in over the next 6 years, passed in separate legislation); Medicaid; small business plans; and individual health
plans.

Third, there is no mention in the Act of the mental health/substance abuse diagnostic categories which must be covered if a mental health/substance abuse benefit is offered, or the length of treatment that must be provided. 'Medical necessity' can still be determined by public or private insurers in these areas, though it is likely that attempts to limit parity to certain diagnostic categories will be under more scrutiny.

This Act must be implemented by the Departments of Labor, Health and Human Services, and the Treasury by October 3, 2009.

Many thanks once again to all of you who responded to the legislative alerts I and others sent requesting your help in contacting members of Congress. Your actions contributed to this achievement.

Laura Groshong, LICSW


Laura W. Groshong, Director, Government Relations
Clinical Social Work Association
lwgroshong@clinicalsocialworkassociation.org

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Susan Post
susan.post@gmail.com
(301)652-5699

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