Mental Health Act Work Persists

NASW submitted public comments for the interim final rules, or IFR, implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act.

The association offered praise for the IFR’s “groundbreaking measures to improve patient access to mental health and substance use disorders coverage.”

The IFR aims to align health plan benefits in mental health and substance use disorders with health plan coverage for medical/surgical benefits. At press time, the IFR was expected to be effective for insurance plans that begin on or after July 1 of this year.

The IFR provides specific examples of acceptable and unacceptable health plan structures under the act.

Overall, the act requires group health plans that offer mental health and addiction benefits and medical and surgical benefits to treat both types of benefits equally in terms of out-of-pocket costs, coverage limits and reimbursement practices.

The IFR was released in February and was based on a review of 400 comments, including those made by NASW as a member of a coalition of mental health groups. From that time until May 3, the departments of Health and Human Services and Labor and the Internal Revenue Service offered a public comment period. NASW Executive Director Elizabeth J. Clark, on behalf of the association, sent comments that expressed strong support for the IFR and offered to aid in its implementation.

The letter noted that clinical social workers are the largest single group of mental health providers in the U.S. and that the IFR effectively implements the letter and spirit of the mental health parity and addictions equity act. It also improves clinical social workers’ ability to serve clients.

Among the suggestions, NASW:

  • Supports the retention of the standard for annual and lifetime dollar limits to be treated similarly for mental health and substance use disorder (MH/SUD) benefits and medical/surgical benefits.
  • Requests equitable treatment for MH/SUD treatment in the methods used to determine usual, customary and reasonable rates of provider reimbursement.
  • Asked for examples in the final rule of the acceptable scope of the medical necessity reviews for MH/SUD treatment as compared to medical/surgical reviews to avoid inappropriate invasions of patient privacy.
  • Believes the IFR should clarify that out-of-network providers have a right to the disclosure of a health plan’s medical necessity criteria relating to services they have provided for plan participants. Out-of-network providers who have provided covered services for a health plan member should have access to the medical necessity criteria and the regulations should be revised to require disclosure to providers who render covered services to plan members.
  • Suggests additional clarification on the acceptable and unacceptable parameters for the exclusion of specific conditions or disorders, so that the purpose of the law is not thwarted. NASW requests additional discussion of acceptable and unacceptable disorders, specific exclusions from coverage or acceptable and unacceptable examples of the bases on which such exclusions may be made.

Sherri Morgan, associate counsel for the NASW Legal Defense Fund and Office of Ethics and Professional Review, said that while the IFR is favorable to real reform in mental health and addictions treatment insurance coverage, it is being challenged in court by behavioral health insurers as going beyond the scope of the authorizing legislation. Morgan noted that NASW also joined in comments supportive of the IFR through the Mental Health Liaison Group.

For more information, review the Legal Defense Fund articles: