Federal Parity Law Now in Effect - Is It Working For You?
For many group health plans, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act went into effect on January 1, 2010. The new law requires most group health plans to cover treatment for mental illness and substance use disorders on the same terms and conditions as medical conditions such as diabetes, heart disease, cancer and asthma. Specifically the new law bars health plans from imposing durational treatment limits (caps on inpatient days or outpatient visits) or financial limitations (higher cost sharing, deductibles or out of pocket limits) that do not also apply to medical-surgical coverage.
The effective date of the new law is actually the beginning of the first new plan year after October 3, 2009. The new law applies to all group health plans sponsored by employers with 50 or more workers.
- Click here to view NAMI's factsheet on the new law
- Click here to view a powerpoint presentation on the new law
Is Your Health Plan in Compliance With Parity?
NAMI is seeking information from individuals and families on how the new law is working. This information is critical to informing policymakers in the U.S. Congress and the Obama Administration on additional steps that may need to be taken to strengthen the law and ensure adequate enforcement. In addition, it is critical for NAMI to demonstrate to the larger public that parity is making a real difference in improving coverage of mental illness treatment and expanding access to critical medical services for children and adults living with mental illness.
Share Your Story
Individuals and families are strongly encouraged to share their personal experiences with parity implementation - both positive and negative. Are you or your experiencing any of the following?
- Is your health plan still imposing an arbitrary limit on covered inpatient days or outpatient visits for behavioral health coverage?
- Is your group health plan applying a separate lower deductible or higher cost sharing for outpatient mental health services?
- Have you noticed improved coverage for mental illness treatment in your group health plan in 2010, e.g. lower cost sharing, a lower deductible or elimination of a treatment limitation such as a cap on outpatient visits? Is so, the new parity law is already making and difference and we want to hear from you.
- Is your group health plan still using a separate deductible that applies only the plan's behavioral health benefit? If so, they are likely doing so in violation of the new parity law.
Share your story on the new parity law by posting on the parity discussion group at www.nami.org/discussion/parity.
Parity Regulations Expected Soon
The Obama Administration is in the process of issuing interim final regulations implementing the new law and setting forth specific standards for how group health plans are to eliminate restrictions on mental illness treatment coverage and ensure equity with respect to application of managed care practices and scope of services.
Last spring NAMI submitted detailed comments to the various federal agencies charged with implementing and enforcing the new law (the U.S. Departments of Health and Human Services, Labor and Treasury) in response to a "Request for Information."