New Mental Health Law Affects Benefits

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) signed by George Bush as part of the financial rescue package in October 2008 will take effect 1/1/2010. This law greatly affects mental health professionals and billers.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 made changes to the Mental Health Parity Act (MHPA) of 1996 which allowed for too many restrictions to mental health benefits. The problem with the 1996 act was that it allowed for too many loopholes and still encouraged discrimination against mental health benefits.

The 2008 Act closed up some of those loopholes. For example, the 1996 MHPA allowed employers to limit the number of visits for mental health treatment whereas the 2008 Act states that mental health benefits can be no more restrictive than medical benefits.

The new law attempts to make coverage for mental health benefits equivalent to medical service benefits. If a health plan allows for out of network benefits for medical services, they must now allow the same out of network benefits for mental health.

The major provisions for the new law are:

• Does not allow employers or insurers to place stricter limits on mental health services than they have on medical benefits. This means not allowing higher co-pays, deductibles or limiting the number of visits.
• If a policy allows for out of network benefits for medical benefits it must allow the same out of network benefits for mental health.
• If a policy allows benefits for substance abuse, both in and out of network, the limitations cannot be more restrictive than they are for medical or mental health benefits.
• Any state parity measures are left in place.

We currently see many policies paying only 50% of the allowable with the patient responsible for the remaining 50%. Under the new law this will no longer be possible unless the health plan pays only 50% of the allowable for medical benefits as well as mental health. We have even seen mental health plans that pay only $10 per visit.

The Act unfortunately does not cover all insured people. Employers with 50 or less employees are exempt from this Act. Also, the law does not require health insurance plans to cover mental health and substance abuse disorders. It only applies to plans that have coverage for mental health or substance abuse.

What does this mean to the mental health provider? Mental health providers will not see as much discrimination for their services. Patients will not be penalized for seeing mental health professionals and will receive equal benefits.

It’s not a perfect solution and doesn’t cover everyone, but it is definitely a step toward equal benefits.

Mental Health Billing

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