PALM BEACH GARDENS, Fl. November 14, 2013- PRNewswire-USNewswire —
The Departments of Treasury, Labor and Health and Human Services issued a final rule on Friday November 8, 2013 governing the implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). While further analysis may be required to digest the complexities of the 200 page rule, The National Association of Addiction Treatment Providers (NAATP), which initiated the groundbreaking NAATP Parity Study seeking accurate and reliable information regarding parity compliance, welcomes the final ruling and has identified for its members a brief summary of key provisions.
The final rule requires health plans to apply parity to intermediate levels of care, such as residential treatment and intensive outpatient settings. And it requires plans to disclose to their members the standards they are using in setting benefits and the reasons for denying a claim. In general, the final rule is effective for plan years beginning on or after July 1, 2014. In practice, the bulk of plan years end December 31st, so the effective date for most insured will be January 1, 2015.
In the final rule, regulators eliminated a provision that had allowed insurers to make exceptions to certain benefit requirements based on “clinically appropriate standards of care.” Federal regulators made the change after hearing from clinical experts that the exception was unnecessary and could be abused by health plans.
The new rules will affect most health plans in the employer and individual markets, including plans being sold on the new health insurance exchanges. The regulation does not require health plans to cover mental health and addiction services, but if plans do cover these services, then they must be in parity with medical and surgical benefits.
Statement of Michael Walsh, President and CEO of NAATP
“The National Association of Addiction Treatment Providers applauds the release of the final rules for the Mental Health Parity and Addiction Equity Act. The release of the final rules, for which NAATP has been striving for the past year and more, will help to guarantee that the promise of the law is fully realized and that access to care is expanded for millions of Americans, particularly those with addiction.
The parity law, which also applies to policies sold through the exchanges under the Affordable Care Act (ACA), is a true milestone recognizing how critical mental health is to overall American health. In general, the final rule is effective for plan years beginning on or after July 1, 2014. In practice, the bulk of plan years end December 31 so the effective date for most insured will be January 1, 2015, and NAATP will again be a leader in helping the industry understand implementation guidelines for this Act. We look forward to helping to determine enforcement strategies on the NQTL (Non-Quantitative Treatment Limitations= see Appendix #A) and defining ambiguous language in the rule until its point of implementation in July 2014.
The absence of final rules implementing MHPAEA, in addition to a lack of common terminology, had hindered its place in the treatment industry, and NAATP will again lead a collaborative effort throughout the industry to help develop an understanding of the rule and define ambiguous language in it until its point of implementation next summer.
NAATP created an anonymous survey tool to provide Mental Health and Substance Use Disorders (MH / SUD) treatment facilities with detailed reports outlining the common issues faced by all constituencies attempting to access coverage within those fields. After many years of advocacy in support of MHPAEA, NAATP members have been instrumental in determining how best to universally implement the final rules and their inclusion in The Affordable Care Act (ACA). Our intention is to focus on evidence-based patient care ahead of this new era in fighting the disease of addiction and NAATP continues to be well-poised to take action to ensure that this level of care will be available to all individuals who meet the necessary criteria for treatment.
The NAATP Parity Study continues to provide a detailed platform, open to all providers within the MH/SUD fields, for all constituencies to get accurate and reliable information regarding parity compliance, and we made it available to decision and policy makers on a National and State level as a prelude to Friday’s ruling.
As an industry, we had to come together to focus on patient care and to shape a collaborative relationship with payer parties, as well as National & State Government, and Friday’s ruling shows the importance of our recent collaborations between the current NAATP board, its directors and committee members, our NAATP-Political Action Committee in Washington, DC, and lawmakers who see that our leadership by example is making a visible difference.
We look forward to continuing our strategic alliances as we continue this battle to provide quality treatment services and educate not only the members but the general public about what that entails.”
About the National Association of Addiction Treatment (www.naatp.org) 561-429-4527:
Founded in 1978, NAATP’s mission is to provide leadership, advocacy, training and other member support services to assure the continued availability and highest quality of addiction treatment.
APPENDIX A- RELATED LINKS
Final regulation, available at www.dol.gov/ebsa/pdf/mhpaeafinalrule.pdf
FAQs about ACA Implementation Part XVII and Mental Health Parity Implementation, available at http://www.dol.gov/ebsa/faqs/faq-aca17.html
U.S. Department of Health and Human Services’ Study: Consistency of Large Employer and Group Health Plan Benefits with Requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, available at www.dol.gov/ebsa/pdf/hhswellstonedomenicimhpaealargeemployerandghpbconsistency.pdf
News release, available at http://www.dol.gov/ebsa/newsroom/2013/13-2158-NAT.html
Non-Quantitative Treatment Limitations (NQTLs)
The final rule strikes the provision included in the IFR that permitted plans to apply discriminatory limits on mental health/substance use disorder (MH/SUD) treatment if there was a “clinically recognized standard of care that permitted a difference.”
Under the final rule, parity requirements for NQTLs are expanded to include restrictions on geographic location, facility type, provider specialty and other criteria that limit the scope or duration of benefits for services (including access to intermediate levels of care). The net effect of this is plans will no longer be able to require a patient to go to an MH/SUD facility in their own state if the plan allows plan members to go out of state for other medical services.
The final rule does not include a new quantitative floor or formula on how plans may apply NQTLs to MH/SUD.
The final rule maintains the “comparable and no more stringently” standard on NQTLs without defining the term and continues to require plans to disclose the “processes, strategies, evidentiary standards and other factors used by the plan or issuer to determine whether and to what extent a benefit it subject to an NQTL be comparable and applied no more stringently for MH/SUD than for medical/surgical.”
The improvement in the final rule is that plan participants or those acting on their behalf will now be able to request a copy of all relevant documents used by the health plan to determine whether a claim is paid (see disclosure section for more detail on what documents may be requested. Current or potential enrollees may request this information and plans are required to provide it within 30 days).
The final rule confirms that provider reimbursement rates are a form of NQTL. The preamble clarifies that plans and issuers can look at an array of factors in determining provider payment rates such as service type, geographic market, demand for services, supply of providers, provider practice size, Medicare rates, training, experience and licensure of providers. The final rule reconfirms that these factors must be applied comparably and no more stringently on MH/SUD providers. Additional comments will be solicited if questions persist with respect to provider reimbursement rates.