07/15/2009
Mental Health Parity Act and other changes effective Oct. 15, 2009
Both Michelle's Law and the Mental Health Parity Act were signed last October and will be effective this October. Both laws impact renewals and new sales.
Michelle's Law allows for full-time college students—if they are covered by a parent's health plan—to maintain their coverage for up to 12 months while taking a medical leave from school or changing to a part-time student status. It is named for Michelle Morse, a college student who was diagnosed with colon cancer and continued to take a full-time course load in an effort to maintain her coverage because COBRA was unaffordable. The extension applies only if loss of student status is the reason for losing coverage (such as those plans that have student age limits). This law will be effective Oct 9 and impacts new sales and renewals beginning Oct. 15, 2009. To learn more about this law and to see if it applies to your groups, contact your Sales representative.
The Mental Health Parity Act (also called the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008) was signed into law on Oct. 3, 2008. It requires that group health plans and group health insurers apply treatment and financial limits to mental health and substance use disorder benefits that are equivalent to (or better than) the treatment and financial limits on medical and surgical benefits. The law removes any day or visit limits or financial maximums that have been imposed on mental health or substance use disorder benefits if the limits or maximums are more restrictive than the predominant ones on medical and surgical benefits. However, the Act does not require health plans to provide mental health/substance use disorder benefits; it applies only to health plans that include these benefits.
The Federal Mental Health Parity (MHP) law becomes effective Oct. 3, 2009. It applies to fully insured and self-insured groups of 51+ and mandates equalization of copays, coinsurance and deductibles, along with the elimination of day and visit limits and financial maximums. It applies to new sales and renewals on or after Oct. 3, 2009, for ERISA groups of 51+ in size, including ASC and church groups. Non-governmental ASC groups that currently have a modified benefit must now become compliant. Non-federal government ASC groups must be compliant unless they choose to meet certain opt-out requirements. Washington groups of 2-50 are not impacted by the federal law. Washington passed its own law in 2007, which will extend parity to groups 2-50 effective July 1, 2010. We will share this information and the changes described below with your clients at their renewal.
The effective date for new groups will be Oct. 15, 2009. The benefit will be enhanced for our existing groups at their renewals beginning Nov. 1, 2009. For non-federal governmental ASC groups, we will include MHP rates in their quote and renewal calculations. It will be up to the group to notify us of their choice to opt out.
A non-federal governmental plan (e.g., a plan maintained by a county, city or school district) may opt out of federal mental health parity if:
- The plan is self-funded (and any reinsurance is not subject to state regulation as insurance)
- The plan sponsor provides written notice of the opt-out to plan participants at enrollment and annually thereafter, including disclosure of the consequences of the opt-out
- The plan sponsor mails notice of its decision to opt out to the Centers for Medicare & Medicaid Services (CMS) before the beginning of each plan year
Please note that we are not authorized to give legal advice to our groups. For legal consultation, each group will need to contact their respective legal department. Visit the CMS Web site to learn more about the opt-out process. Federal rules for the new law are not yet published and might not be available until after the effective date.
Under the new law, utilization management activities are still allowed and are effective for managing the quality and cost of mental health and chemical dependency care.
Regence's Care Management program has a comprehensive program of mental health and chemical dependency benefit management and network or provider panel management. Regence Care Management is experienced in managing parity benefits in Oregon and in all our states for the Federal Employee Program. Although there are external vendor organizations that conduct behavioral health care management, Regence strongly believes that our integrated, whole-person model of care management is better for members and is more cost-effective in the long term.
Mental health and chemical dependency changes apply to all groups of 51+ on medical products and special enrollment changes apply to all groups. Following are the Summary of Benefit Changes and Contract Language Clarifications that apply to the following products:
ActivateSM, Innova® and Engage® and Regence HSA Healthplan 2.0SM products: Summary of Benefit Changes and Contract Language Clarifications
All other Regence products: Summary of Benefit Changes and Contract Language Clarifications
Self Funded Groups: Summary of Benefit Changes and Contract Language Clarifications
If you have any questions, please talk to your Regence Sales contact.
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