A health law expert says patients may have a hard time using the new federal mental health benefits parity requirements.
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) prohibits large group health plans that offer mental health benefits from applying financial requirements or treatment limitations that are more restrictive than the requirements and limits for medical benefits.
The U.S. Department of Health and Human Services recently issued a regulation building the MHPAEA parity standards into the “essential health benefits” (EHB) package.
In most cases, the Patient Protection and Affordable Care Act (PPACA) requires nongrandfathered individual and small-group plans to cover at least 60 percent of the actuarial value of the EHB package.
Elizabeth D. Edwards revised the parity requirements for the National Health Law Program — an organization that represents low-income clients and people in “underserved communities” — and found challenging suspected parity violations in court could be difficult.
The idea that requirements for mental health and substance abuse benefits should be no more restrictive than the requirements for medical benefits “is relatively simple,” Edwards writes in a parity report.
But, in practice, doing the analysis necessary to prove a violation of the parity rules is complicated, Edwards says.
Few outside a “small community of health economists” will be able to perform the analysis, and the economists will need help from regulators to get the information needed to assess parity, Edwards says.
“One suspects that it will be difficult for advocates, much less actual group plan participants, to determine whether a plan has violated the parity mandates,” Edwards says.
But, on the bright side, Edwards says, fears that employers might respond to the MHPAEA by dropping mental health or substance abuse benefits altogether, rather than offering benefits parity, have not come true.
So far, most employers that offered mental health benefits before 2008 are still offering mental health benefits, Edwards says.