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Connecticut Department Sets Up Mental Health Provider Co-Pay Procedure

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Connecticut health insurers may be able to set the co-payment level for mental health providers at the same level used for medical health specialists.

Thomas Leonardi, the Connecticut insurance commissioner, discusses mental health provider co-payment levels in Bulletin HC-87, an advisory that explains how to handle one issue involving the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

MHPAEA now requires employers with 51 or more employees that offer mental health benefits along with medical coverage to apply the same financial requirements both to medical care and to mental health care.

Before MHPAEA came along, Connecticut had an even tougher parity law in place that required both individual and group plans to cover the diagnosis and treatment of mental conditions. The Connecticut parity law continues to apply when the Connecticut law is tougher than the federal law.

Connecticut had been letting plans use different co-payment levels for primary care doctors and specialists, and it had been letting plans count mental health providers as specialists, Leonardi says.

Connecticut stopped letting insurers use that approach in July 2010, when MHPAEA started to take effect.

U.S. Department of Health and Human Services (HHS) officials implied in the preamble to the regulations implementing MHPAEA that a plan had to set the co-payment level for mental health providers at the same level used for primary care doctors, Leonardi says.

HHS later decided that insurers can set mental health provider office visit co-payments at specialist levels if the co-payment requirement is no more restrictive than the predominant requirements applied to “substantially all” other medical and surgical benefits.

If a Connecticut carrier wants to set large-group mental health provider co-payment levels at the specialist level, then it must file a report showing that the plan passes the MHPAEA “predominant” and “substantially all” tests, Leonardi says.

After getting initial approval for the co-payment arrangement, an insurer must demonstrate its compliance every year and get a member of the American Academy of Actuaries to certify the demonstration, Leonardi says.

- Allison Bell

Other MHPAEA coverage from National Underwriter Life & Health: