In 2008, Congress enacted the Mental Health Parity and Addiction Equity Act (“MHPAEA” or the “Act”). Subsequently, in 2013, the Departments of Treasury, Labor and Health and Human Services issued the first rules implementing the Act. This Act applies to certain public and private health insurance plans, including employer group plans and requires that benefits offered for mental health and substance abuse conditions be on a par with those offered for medical and surgical conditions.
The MHPAEA does not require plans that don’t already do so to offer mental health and/or substance abuse disorder benefits. The Act only applies to a plan that already offers mental health and substance abuse benefits in addition to medical and surgical benefits. If the plan does not offer any mental health or substance abuse disorder benefits, then compliance with the MHPAEA is not required.
If the MHPAEA applies to a plan, then the plan must offer mental health and/or substance abuse disorder benefits in the same manner for which it offers medical and surgical benefits. Insurers must apply financial requirements (copayments, deductibles) and treatment limitations (number of visits, scope of treatment) to mental health or substance abuse disorder benefits that are no more restrictive than those applied to substantially all medical and surgical benefits in the same classification.
Impact on Providers
The potential impact of the MHPAEA on mental health and substance abuse disorder providers is anticipated to be a significant increase in the number of patients seeking such treatment. It has been estimated that the MHPAEA, and the Affordable Care Act, will provide increased coverage for mental health and substance abuse disorders to 31.1 million people. These will most likely include: people who have previously not sought treatment due to a lack of insurance coverage and people who previously had sought limited treatment due to coverage limitations.
Providers should be aware that the MHPAEA has not changed the standard of provider care. Providers will still be held to the same high standard for patient care and management. Providers should avoid accepting more new patients than they can properly care for and manage. A provider should be keenly aware of how increased patient loads may adversely impact frequency and/or length of treatment sessions. Cases that have sought to hold a provider responsible for the adverse consequences of a patient’s actions, particularly suicidal or violent acts, often point to these aspects of treatment as falling below the standard of care.
Another factor to be considered in determining the number of new patients a provider can accept is the amount of time required to seek reimbursement from a patent’s insurance plan. The regulations require increased transparency by insurers who decline or limit coverage for mental health or substance abuse disorders. Insurers may require more exhaustive paperwork from providers to ensure that coverage is being properly applied or denied.
In conclusion, the MHPAEA will allow many new patients to seek mental health and substance abuse disorder treatment because insurers will be covering such care and greater levels in order to provide parity with medical and surgical coverage. Providers should be conscientious in deciding how many new patients can be effectively treated and managed in order to avoid increased exposure to potential liability for the actions of patents.
Disclaimer: This article is designed to provide information enraged to the MHPAEA. It is provided with the understanding that the author is not rendering legal advice or services. If legal advice or other expert assistance is required, the services of a competent professional should be sought.
Roger L. Hillman is a Mediator/Arbitrator with Pacific ADR Consulting, LLC. See his press kit.