Parity Interim Final Rule Guidance Released

On January 29, 2010, the federal departments of Health and Human Services, Labor and Treasury released their “guidance” on the Wellstone-Dominici Mental Health Parity Act. The National Council discussed some of the contents of the Interim Final Rule (IFR) in their February 4 Public Policy Update. The IFR goes into effect April 5, 2010 and applies to policies with plan years that start on July 1 or later.

Since some insurance carriers have already begun changes in their policies and claims filing procedures in an attempt to meet the requirements of law, it is possible that procedures just put in place may be changed. For example, Blue Cross/Blue Shield of Florida, a company that had a limit of 25 sessions per year for psychotherapy with no authorizations required for most plans, in January started to require authorization for all mental health services. According to the information provided by The National Council, this may need to change again.

Group insurance plans for groups of 50 or more may need to carefully match how they manage medical/surgical and mental health/addictions benefits. It is not just the “quantitative limits” that must be the same; the “non-quantitative limit” also must be the same. The IFR forbids plans from using specific non-quantitative limits unless similar restrictions exist for medical/surgical benefits: medical management, prescription formulary design, “fail-first” or step therapies, and prior authorization.

The National Council has continued discussion of the IFR in several articles on their web site. Take a look at their press releases, policy issues and resources, and slides and recording from a recent health care reform webinar. The National Council does a wonderful job of staying on top of and advocating for issues of this sort and should be on your radar all the time.

The American Psychological Association also advocated strongly for this law and information about its implementation can also be found at the APA web site. More detailed and current information about the IFR has been shared with state psychological associations and should be available to APA members who are connected with the practice organization. The email I received through Florida Psychological Association contained a thorough analysis of the IFR along with examples and hypotheticals. A quick read of this article suggests that it will not be a simple matter for a provider or a consumer to determine if their insurance carrier is following the rule. I am hopeful that simpler guidelines will follow.

Dr. Ronald Manderscheid’s article in Behavioral Healthcare Magazine suggests that this law is just the first step in our move toward parity in payment for mental health and substance abuse services. Four other doors need to be opened more widely to assure true parity: 1. the extension of insurance benefits to more individuals and the extension of the rule to more policies; 2. clear statement of what determines medical necessity for access to care; 3. improving scope and quality of the care accessed; and 4. expecting the outcome of care to be at least as good as in the medical/surgical realm. This law brings us a long way toward the goal of equity, but we as advocates have a long way to go to assure that consumers of mental health care can actually get the care they deserve.

What effect do you think the parity law will have on your organization? Do you foresee a big impact or a small change? Please share your comments below.

0 thoughts on “Parity Interim Final Rule Guidance Released

  • We are seeing parity to mean deductibles are being applied where the were bypassed before. Also we have seen copays for more than 50% of the contracted rate.

    As usual do not know that the law will produce the desired result.

    • Thanks for your comment, Deb. I’m not sure I understand what you mean by “deductibles are being applied where they were bypassed before.” Before this IFR was released, I think companies were trying to do what they interpreted the law to mean. Now they are finding out what the law actually means!

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