The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was signed into law by President Bush on October 3, 2008, as part of the Emergency Economic Stabilization Act. Like current mental health parity rules, the new law does not require group health plans to provide mental health and substance abuse benefits. However, group health plans that provide such benefits must provide parity between mental health and substance abuse benefits and medical/surgical benefits. The following chart shows the changes between existing and amended mental health parity law.
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Existing Law
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Amended Law
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- Covers only mental health benefits and does not cover benefits for substance abuse or chemical dependency treatment
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- Specifically covers both mental health and substance use disorder benefits
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- Prohibits health plans that offer mental health benefits from setting lower annual and lifetime spending limits for mental health treatments than for physical ailments
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- Maintains the prohibition on lower annual and lifetime spending limits for mental health treatments but also requires plans offering mental health or substance use disorder benefits to establish deductibles, co-pays, out-of-pocket expenses, coinsurance, covered hospital stays and covered outpatient visits that are no more restrictive for mental health and substance use disorder benefits than for medical/surgical benefits
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- No requirements regarding parity for out-of-network providers
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- New requirement that plans covering mental health or substance use disorder benefits that permit out-of-network coverage for medical or surgical benefits must also permit such coverage for mental health or substance use disorder benefits
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- No requirements regarding availability of plan information
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- New requirement that criteria for medical necessity determinations made under the plan with respect to mental health or substance use disorder benefits and the reasons for any claim denials with respect to mental health or substance use disorder benefits be made available to plan participants, beneficiaries or contracting providers (as applicable) upon request
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- Cost exemption if increase in cost to plan is at least one percent
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- Cost exemption for one plan year if increase in actual total plan cost for the plan year is two percent in the first plan year and one percent in each subsequent plan year
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Under the new law, implementing agencies must publish regulations by October 3, 2009. The new law applies to group health plans (other than collectively bargained plans) for plan years beginning after October 3, 2009 (January 1, 2010 for calendar year plans). Collectively bargained plans must comply with the new law by the later of January 1, 2009, or the date on which the last of the collective bargaining agreements relating to the plan terminates. Existing mental health parity law (which would have otherwise expired under a sunset provision) remains in effect until superseded by the new law. Sponsors of health plans offering mental health and substance use disorder benefits should review these requirements and make changes to their plan design, documentation and communications in order to comply with the new law.
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