The Mental Health Parity Act of 2008 will equalize health plan benefits between mental health (i.e., depression, schizophrenia or eating disorders), substance use disorders (i.e., alcohol or drug abuse) and medical / surgical (i.e., cancer, broken bones or heart disease) benefits for group health plans with more than 50 employees. This law applies to the plans that provide mental health benefits. When the law is enacted, 113 million people across the country will have the right to non-discriminatory mental health coverage, including 82 million individuals enrolled in self-funded plans (regulated under ERISA), who cannot be assisted by State parity laws. The expansion of the parity requirements, including the self-funded health plans, are significant achievements that will have a substantial positive impact on patient access to care.

HealthWatch^TM encourages self responsibility through its employee education programs and activities directed at early identification and effective treatment. The areas of interest for the Mental Health Parity are Stress Management and Depression within GPA’s Lifestyle Coaching and Care Coordination services.

In addition, the Employee Assistance Programs (EAP) will become a key player in providing service and controlling utilization of services. HealthWatch is the point of contact for all EAP calls related to Mental Nervous admissions or treatment for groups. HealthWatch professionals will triage the calls to the appropriate health care professionals to expedite referrals to appropriate providers and review over-utilization or under-utilization of care.

GPA Account Managers will provide additional information and specific plan design adjustments for your consideration.

The Mental Health Parity Act of 2008 accomplished several new steps toward achieving mental health parity including:

• Expanding health plan coverage to include treatment of substance use disorders.
• Requiring financials for mental health and substance use disorders treatment to be equivalent to any requirements for physical and/or medical problems: this refers to deductibles, co-payments and out-of-pocket expenses that patients are expected to pay. For example, treatment for medical/surgical procedures including frequency of treatment and number of visits and days of coverage are to be the same for mental health / substance abuse treatment procedures.
• The health plan must make mental health / substance use disorder medical necessity criteria available to current or potential participants, beneficiaries or providers upon request.
• A plan must make reasons for payment denials available to participants or beneficiaries on request or as otherwise required.
• A plan may not apply separate cost sharing requirements or treatment limitations to mental health and substance use disorder benefits.
• Coverage for treatment by out-of-network providers shall be the same for mental health / substance use disorders and for medical/surgical services.

The bill will become effective January 1, 2010 for most health plans.