On March 21st, 2010, the House of Representatives passed comprehensive health care reform legislation (H.R. 3590) and the President signed it into law the next day. This historic legislation will expand health care coverage to 32 million Americans who are currently uninsured. In addition, it includes insurance market reforms that will improve access to care for all and a number of provisions to slow the growth of health care costs and improve quality.

Health care coverage will be expanded through two mechanisms: 1) private insurance plans offered through state-administered markets (called "exchanges" in the bill) and 2) an expansion of Medicaid coverage up to 133% of poverty ($14,404 for individuals; $29,326 for families of four). A requirement that everyone must have insurance will push younger, healthier individuals to join the exchanges thus helping to defray the costs of those in need of more care. To lessen the burden of this new mandate, premium and cost-sharing subsidies will be available for those under 400% of poverty ($43,320 for individuals; $88,200 for families of four). Employers are also encouraged to offer health insurance through fines for larger employers and tax credits for smaller businesses. The expansion of Medicaid would be financed predominantly with federal funds.

This legislation significantly builds upon our accomplishments in enactment of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). In the health care reform law, mental health and substance use services are treated as required benefits thus filling the gap in MHPAEA that allows plans to leave out mental health and substance use coverage altogether. In addition, the health reform law extends MHPAEA to plans available to small businesses and individuals through the state-based exchanges thus overstepping the exemptions for these groups included in the 2008 parity law.

Other insurance market reforms will require all plans to offer and renew coverage for all who apply (guaranteed issue). Pre-existing condition exclusions will be prohibited. Premiums can only be based on family structure, geography and age (as well as tobacco use). And, lifetime limits on benefits will also be prohibited as will annual limits eventually.

Among the provisions to improve health care quality is a new Medicaid option to establish medical/health homes to improve care coordination. Individuals with serious mental health conditions are explicitly qualified to participate. In addition, this legislation includes many provisions to improve access to preventive services including through home visitation programs and school-based health clinics.

Education loans and training programs are targeted to address shortages of mental health and addiction treatment providers. And, new programs to support additional research on depression are authorized. In addition, closing the donut hole in the Medicare prescription benefit will help millions of people with mental health or substance use conditions.

A set of modifications to this health care reform legislation was also passed by the House immediately after passage of the underlying bill. These modifications were approved by the Senate on March 25 and the House followed by approving minor changes to what it had originally approved. ::

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On January 29th, the federal Departments of Labor, Health and Human Services, and Treasury released the interim final rule for the 2008 Mental Health Parity and Addiction Equity Act. Insurance plans should currently be making a best faith effort to comply with the law, which went into effect on October 3, 2009 without the benefit of regulations. The regulations became effective on April 5, 2010 and apply to plan years beginning on or after July 1, 2010. 

The much anticipated regulations outline the quantitative and non-quantitative treatment limitations that must be
in parity with the treatment limitations for medical/surgical benefits. Quantitative treatment limitations include frequency of treatment, number of visits, and days of coverage, and must be at parity with substantially all medical/surgical benefits.  The Departments gave separate guidance with examples of parity with medical/surgical benefits for non-quantitative treatment limitations like medical management and utilization management.  We will be reviewing the non-quantitative treatment limitations guidance to ensure that the regulations
cover all scenarios where treatment can be limited by these types of mechanisms. 

The Departments identified six categories of services that must be in compliance; in-network inpatient treatment, out-of-network inpatient treatment, in-network outpatient treatment, out-of-network treatment, emergency services, and prescription drugs. Plans offering mental health and substance use coverage must provide parity in all classification areas where medical/surgical benefits are offered. 

The Departments are looking for comments on the interim final rule in three specific areas; non-quantitative treatment limits, scope of service, and disclosure requirements regarding medical necessity, coverage denials, and cost exemptions.  It is strongly suggested that mental health advocates also include in their comments provisions that they especially like, since those who oppose those provisions will comment strongly against them.  Comments are due to the Departments by May 3rd, so look out for Mental Health America’s sample comments so you can also submit your own. 

Mental Health America is monitoring compliance with the law and cases of termination of treatment limitations.  If you have cases of non-compliance or mental health benefit terminations, please visit our parity page to submit your case. ::

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“Mental Health America is monitoring compliance with the law and cases of termination of treatment limitations."

—Mental Health America