Thursday, March 6, 2008
Yesterday, the House of Representatives passed the Paul Wellstone Mental Health and Addiction Equity Act. The gavel describes the Act as follows:
The House has just passed H.R. 1424, the Paul Wellstone Mental Health and Addiction Equity Act by a vote of 268-148. This bipartisan legislation will end discrimination against patients seeking treatment for mental illnesses by prohibiting insurers and group health plans from imposing treatment or financial limitations when they offer mental health benefits that are more restrictive from those applied to medical and surgical services.
More precisely, the Act:
Requires equity in financial requirements. Under the bill, an insurer or group health plan must ensure that any financial requirements – such as deductibles, copayments, coinsurance, and out-of-pocket expenses – applied to mental health and addiction benefits are no more restrictive or costly than the financial requirements applied to comparable medical and surgical benefits that the plan covers.
Requires equity in treatment limits. Under the bill, a group health plan must ensure that the treatment limitations – such as frequency of treatment, number of visits, and days of coverage – applied to mental health and addiction benefits are no more restrictive than the treatment limitations applied to comparable medical and surgical benefits that the plan covers.
Does not mandate mental health benefits. The bill does not mandate insurers or group health plans to provide any mental health coverage. The bill’s provisions only apply to plans that choose to offer mental health coverage.
Exempts certain businesses. The bill exempts small businesses with 50 or fewer employees. It also exempts those businesses that experience an overall premium increase of 2 percent or more in the first year and 1 percent in subsequent years.
Covers same mental illnesses and addiction disorders as FEHBP. The bill ensures that group health plans cover the same range of mental illnesses and addiction disorders covered by the Federal Employees Health Benefits Program – i.e., the mental illnesses and addiction disorders included in the mental health practitioner’s guide, the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Does not mandate out-of-network benefits. The bill simply states that if a plan already offers out-ofnetwork benefits, it must offer out-of-network benefits on the same terms for mental health services as it does for medical and surgical services.
Does not pre-empt stronger state parity laws. The bill establishes a federal standard, a floor of protections that would apply to job-based health coverage, but allows states to be more protective of their residents with stronger parity laws.
Explicitly permits medical management of health benefits. The bill allows the use of medical management tools that are based on valid medical evidence and pertinent to the patient’s medical condition so that specific coverage is not arbitrary in its application and more transparent to the patient.
Provides for enforcement. The bill provides remedies to protect beneficiaries’ rights and permits enforcement of the bill’s equity requirements by the Internal Revenue Service, the Department of Health and Human Services, and the Department of Labor.
The Senate had already passed a mental health parity bill earlier. The New York Times has a more detailed discussion of the politics behind the Act's passage and the ability of the House and Senate to reach a compromise and send the Act to the President.