HHS Seeks Local Comments on Mental Health Parity Rules

Article excerpt

Interim regulations governing the implementation of the Mental Health Parity Act (MHPA), and a request for public comment, were published in the December 22, 1997, of the Federal Register. The law became effective January 1, 1998 and will sunset September 30, 2001 unless there is further Congressional action.

The MHPA requires issuers and plans, including municipal health insurance pools, and individual municipalities, that provide mental health benefits, to apply the same aggregate lifetime limit and annual limit used for medical/surgical services. If a group health plan offers two or more benefit packages under the plan, the requirements of the Act and the interim rules apply separately to each package. The rules clarify that the laws requirements apply regardless of whether the mental health benefits are administered separately under the plan. Further, the rules clarify that the requirements apply to both group health plans and to health insurance issuers offering coverage in connection with a group health plan.

The MHPA provisions and implementing rules do not require any group plan or coverage to provide mental health coverage. Nor do they affect a plan's terms or conditions (including cost sharing, limits on the number of visits or days of coverage, and requirements relating to medical necessity, requirements that patients or providers obtain prior authorization for treatment, and requirements relating to primary care physicians' referrals for treatment) relating to amount, duration, or scope of mental health benefits under a plan or coverage, except as specifically provided in regard to parity of aggregate lifetime dollar limits and annual dollar limits.

The law does not apply for benefits for treatment of substance abuse or chemical dependency.

The law applies to group health plans and health insurance issuers offering group health insurance coverage with a group health plan for plan years beginning on or after January 1, 1998. The interim regulations provide the following ways compliance with the MHPA requirements can be accomplished:

1) The plan or coverage may comply by not including any aggregate lifetime dollar limit or annual dollar limit on mental health benefits. …