Federal Mental
Health Parity and Addiction Equity Act
The Federal Mental Health Parity and Addiction
Equity Act, effective October 3, 2009, prohibits
health plans from placing more restrictive financial
requirements or treatment limitations on mental
health or substance use disorder benefits than
on medical benefits. Beginning October 3, upon
renewal of employer group plans with 51 or more
employees, benefits for mental health or substance
use disorders will be equal to medical benefits. |
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The Act does not apply to:
- Federal Employee Program (FEP) members
- Non-federal government groups that are self-funded
(e.g., school districts, city and county groups)
- Uninsured persons
- Incarcerated individuals
- Medicaid or Medicare beneficiaries
- Small group plans (2-50 members) or
- Individual plan members
For verification of member benefits and eligibility,
please access the Provider Center or contact the Customer
Service number listed on the back of the member
card.
Effective February 1, 2010, Regence will conduct
care management based on the requirements outlined
in the table below. As of this date,
facilities and programs must notify Regence Behavioral
Health of all detoxification, inpatient, residential,
partial hospitalization and chemical dependency intensive
outpatient admissions within the timeframes and at
the contact number indicated below.
Type
of service |
Notification
Upon Admission Required |
Services
Reviewed |
Contact
Number |
Detoxification |
Yes |
Before day 3 |
1 (800) 780-7881 |
Inpatient chemical
dependency |
Yes |
Before day 3 |
1 (800) 780-7881 |
Inpatient mental health |
Yes |
Before day 3 |
1 (800) 780-7881 |
Intensive outpatient mental health |
No |
Before visit 21* |
1 (800) 780-7881 |
Intensive outpatient
chemical dependency |
Yes |
After 8 weeks |
1 (800) 780-7881 |
Outpatient chemical
dependency |
No |
Before visit 21* |
1 (800) 780-7881 |
Outpatient mental health |
No |
Before visit 21* |
1 (800) 780-7881 |
Partial hospitalization
chemical dependency |
Yes |
Before day 3 |
1 (800) 780-7881 |
Partial hospitalization
mental health |
Yes |
Before day 3 |
1 (800) 780-7881 |
Residential chemical
dependency |
Yes |
Before day 3 |
1 (800) 780-7881 |
Residential mental
health |
Yes |
Before day 3 |
1 (800) 780-7881 |
| *Outpatient and mental
health intensive outpatient services are reviewed
when combined services for a member exceed 20 visits
per plan year. Therefore, if a member is receiving
treatment from more than one mental health professional,
each of those professionals will need to submit
a treatment plan prior to the member’s 21st
cumulative visit. |
To request authorization for outpatient or intensive
outpatient services, fax a completed Regence Behavioral
Health Treatment Plan Request Form to
1 (800) 331-3505.
Current care management requirements, effective through
January 31, 2010 are available in the Care
Management section of our Provider Web
Site under Medical Pre-authorization.
The Behavioral Health section of our Administrative
Manual will be updated on February 1, 2010,
to reflect the new care management requirements.
Our care management team reviews and authorizes care
based on Regence
Behavioral Health policies.
Please note below important changes to our
behavioral health policy, effective
February 1, 2010:
- Requests for retrospective review of outpatient
or mental health intensive outpatient services rendered
after the 20th cumulative visit or chemical dependency
intensive outpatient services rendered after the
8th week of treatment will not be processed and will
result in coverage being denied. These denied charges
are considered a provider write-off and may not be
billed to our member.
- Psychiatric diagnostic interview examinations (CPT
codes 90801 and 90802) are limited to
one per member, per provider, per year, unless
prior authorization has been obtained.
10/30/2009
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