(Updated October 2008)
LEGISLATION
S. 558 "The Mental Health Parity Act of 2007" [Sponsor: Senators Pete Domenici (R-NM), Edward Kennedy (D-MA), and Mike Enzi (R-WY)]
passed Senate September 18, 2007 by unanimous consent
H.R. 1424 “Paul Wellstone Mental Health and Addiction Equity Act of 2007” [Sponsors: Rep. Patrick Kennedy (D-RI), Rep. Jim Ramstad (R-MN)]
passed by the House of Representatives March 5, 2008 by a 268-148 vote
H.R. 6983 “The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008” [Sponsors: Rep. Patrick Kennedy (D-RI), Rep. Jim Ramstad (R-MN)] passed by the House of Representatives on September 23, 2008 by a 376-47 vote
H.R. 1424 “The Emergency Economic Stabilization Act of 2008,” including “The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008”
passed by the Senate on October 1, 2008 by a vote of 74-25
passed by the House of Representatives on October 3, 2008 by a 263-171 vote
signed into law by President Bush on October 3, 2008, becoming Public Law 110-343.
LATEST INFORMATION
On October 3rd, 2008 Congress and the president enacted an historic law requiring most private sector health plans to establish parity of insurance coverage for mental health and addictive disorder treatments. Enactment of the law is a victory for the American Counseling Association and other mental health and addictive disorder advocacy organizations, which have been working toward this goal for over a decade. The parity legislation was included in the broad economic recovery legislation developed in response to the recent financial crisis.
The new law, named after the two Senators who pushed through the first federal mental healht parity law in 1996, will take effect for health plan years beginning one year after the date of enactment (October 3, 2009). The law will apply to private sector health plans covering more than 50 employees.
The law does not require that health plans offer coverage of mental and addictive disorder services. However, health plans which provide such coverage must apply the same treatment limits and financial requirements for mental and addictive disorder services that are applied for substantially all other types of covered care. In addition, a health plan which offers out-of-network coverage for medical and surgical benefits must also offer out-of-network coverage for mental and addictive disorder services. The law’s provisions should remove barriers to treatment for millions of Americans, and will help reduce the lingering stigma surrounding mental health and addictive disorder treatment.
Counselors should recognize that while the legislation is a huge step forward in increasing Americans’ access to mental and addictive disorder care, it does not fix everything. The parity law was not designed to address broader managed care and consumer access issues. Health plans will continue to be able to utilize standard managed care practices such as case management and utilization review, and health plans will continue to decide what care is—and is not—medically necessary. Neither does the legislation address issues related to the recognition or reimbursement of counselors or any other particular type of provider, or issues related to Medicare or Medicaid coverage of mental health care.
WHAT YOU CAN DO
Members of Congress appreciate positive feedback! If you get a chance, see how your Representative voted on H.R. 6983. This vote was specifically on the mental health parity legislation, and those Representatives who voted “yes” for parity should be thanked for their support.
In the Senate, the vote held on October 1st was on the large financial rescue proposal, of which parity was a relatively small part, which means that a Senator’s vote does not necessarily reflect his or her position on the parity legislation. However, the Senate approved a similar version of the parity legislation by unanimous consent earlier in the 110th Congress, and so it is appropriate to let Senators how much you appreciate the fact that parity was enacted this year.
You can identify your Representative and Senators by hitting the ACA internet legislative action center at http://capwiz.com/counseling. All Senate and House offices can be reached through the U.S. Capitol Switchboard at 202-224-3121. Postcards and letters should be addressed as follows:
for Senators
The Honorable {full name}
U.S. Senate
Washington, D.C. 20510
for Representatives
The Honorable {full name}
U.S. House of Representatives
Washington, D.C. 20515
BACKGROUND
Health care policies have routinely provided only limited coverage for mental health and substance abuse treatment, taking advantage of the lingering societal stigma regarding such care. This 'second class status' for individuals with mental or emotional disorders is no longer justifiable, and most states have passed laws setting minimum standards for health insurance coverage of mental health treatments. While these laws have helped improve access to treatment, not every state has them, and they do not affect a large and growing segment of the health insurance market: those health plans which are self-insured. These plans are governed by federal and not state law.
In 1996, Congress passed the federal Mental Health Parity Act. This modest law prohibits health plans from instituting separate and unequal dollar limits (either on an annual or lifetime basis) on mental health coverage than were used for general medical care, but still allows plans to use explicit day and visit limits and higher cost-sharing amounts for mental health treatment.
The new parity law, Public Law 110-343, closes these loopholes. Most private sector health plans would be prohibited from applying any cost-sharing requirements or treatment limitations on mental health and substance abuse services which are more restrictive than those used for substantially all other medical and surgical benefits covered by the plan. Health plans could apply for an exemption from the law if they project an actual cost increase exceeding 2 percent of total plan costs in the first year of compliance, or 1 percent in subsequent years. However, exemptions would be allowed for only one year, following which the plan would again need to come into compliance with the law.
The Congressional Budget Office (CBO) projects that mental health parity will increase employers’ health care costs by less than 1 percent.
Information Contact:
Scott Barstow
American Counseling Association
5999 Stevenson Avenue
Alexandria, VA 22304
Phone: (800) 347-6647 x234
Fax: (800) 473-2329
e-mail: sbarstow@counseling.org