NORTHRIDGE, Calif., Nov. 21, 2013 /PRNewswire On November 8, 2013, after five years of deliberation, the Department of Health and Human Services (HHS) issued the Final Rule for the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equality Act (MHPAE) of 2008. The Final Rule details how insurers must cover care for mental health and addiction treatment.
Kantor & Kantor LLP congratulates the Eating Disorders Coalition (EDC) and the Residential Eating Disorders Consortium (REDC) for their instrumental roles in fighting to ensure that the Final Rule provided the fullest protection for patients with eating disorders. Founding partner Lisa Kantor is honored to be a member of the board of the EDC and the advisory board of the REDC. Through avenues such as lobbying and public education campaigns, the EDC and REDC tirelessly strived to provide the protection that those suffering with mental health conditions or addiction deserve. These organizations faced an uphill battle in their efforts to establish parity for those suffering with mental illness and addiction. Parity ensures appropriate treatment is covered by health insurance policies.
Although MHPAE was passed over five years ago, the bill has lacked the clarity and guidelines necessary to hold insurers accountable for mental health and addiction coverage. The Final Rule removes ambiguity from the language of the bill in five significant ways. In the change most substantial for our clients, the Final Rule defines intermediate services such that it requires that medical/surgical care and behavioral health services be handled in a comparable fashion. While the Final Rule does not specifically require that residential services be covered, it does say that if insurers offer "post acute care services" for medical services, then they must also offer coverage for residential treatment and other intermediate services for behavioral health.
"The Final Rule clarifies the intent of the MHPEA," said Kantor. "Not only does this confirm the way insurers must interpret the law, but it lays the foundation for true parity for those seeking treatment for mental illness and addiction. I am confident that the Final Rule for this law will remove significant barriers to those seeking mental health and addiction treatment. Furthermore, this will provide my clients - most of whom suffer with eating disorders - access to life-saving treatment."
Other significant changes include eliminating the term "clinically appropriate exception" from the Non Quantitative Treatment Limits (NQTL) portion of the regulations. This means that plans will no longer be able to require a patient to go to a facility in their own state if the plan allows plan members to go out of state for other medical services. The Final Rule now recognizes Multi-Tier plans and multiple provider networks, so long as they are not more restrictive than similar plans providing coverage for non-mental health or addiction coverage. Under the Final Rule, Managed Care Organizations (MCOs)/Insurance Plans must disclose medical necessity definitions and the process used to construct NQTLs. Finally, the Final Rule provides a formula for how plans and insurers can deal with cost exemptions if the changes necessary to comply with the law raise costs by at least 2% in the first year.
For more on MHPAE and the fight to eliminate mental health parity violations, see http://eatingdisorderscoalition.blogspot.com/2013/11/edc-succeeds-in-parity-push.html.
About Kantor & Kantor, LLP
Kantor & Kantor is the largest law firm in the country exclusively representing plaintiffs who have been denied insurance benefits from life, health, disability, and long-term care policies. The firm has extensive experience with the complex appeals process and federal court litigation of ERISA matters and files more ERISA cases than any other law firm in California. For more information, log on towww.kantorlaw.net, call (800) 446-7529, or follow the firm at http://www.kantorlaw.net/Eating_Disorder_Blog.aspx.