Trump administration officials say a new federal law, the 21st Century Cures Act, clearly extends the Mental Health Parity and Addiction Equity Act of 2008 to anorexia, bulimia and other eating disorders.
Officials write in a new batch of guidance that they believe the MHPAEA itself applies to coverage for eating disorder treatment.
The MHPAEA requires providers of individual coverage, and large group health plans, to provide parity for any mental health services they cover, officials write in an answer to frequently asked questions about the MHPAEA.
“Eating disorders are mental health conditions, and therefore treatment of an eating disorder is a ‘mental health benefit’ within the meaning of that term as defined by MHPAEA,” officials write.
The agencies are asking members of the public to send them comments on whether the 21st Century Cures Act will affect MHPAEA rules for eating disorder coverage by Sept. 13.
Three departments helped prepare the answer: the U.S. Department of Labor, the U.S. Department of Health and Human Services, and the U.S. Treasury Department.
Officials at DOL, HHS and the Treasury Department often team up to handle federal health coverage matters. Observers sometimes refer to the three-agency group as “the tri agencies.”
The MHPAEA does not require an insurer or health plan to cover mental health care.
If, however, a provider of individual or family coverage, or a large employer plan, chooses to cover mental health services, then the coverage for mental health services must be about as rich as the coverage for “substantially all” medical and surgical benefits.
The coverage provider cannot use quantitative treatment limits, such as deductibles, that are more restrictive for mental health care than for surgical care.
Similarly, the coverage provider cannot use nonquantitative treatment limits, such as care preapproval requirements or care review requirements, that are more restrictive.
Under the administration of former President Barack Obama, HHS approved regulations that pushed insurers to build mental health services coverage into most individual and small-group policies.
Insurers can now sell two types of individual or small-group major medical coverage. They can sell coverage that qualifies as the kind of solid health coverage that helps people avoid paying the Affordable Care Act penalty imposed on people who lack solid health coverage. They can also sell coverage that does not qualify as solid health coverage, or “minimum essential coverage.”
Under the HHS regulations, any individual major medical coverage that qualifies as minimum essential coverage must cover mental health and addiction treatment services. The MHPAEA then requires the issuer to provide parity for the mental health services covered and the medical and surgical services covered.
The 21st Century Cures Act
Obama signed the 21st Century Cures Act into existence in December.
The bill passed through the House and Senate with an unusually high level of bipartisan support.
One little-noticed section of the act, Section 13007, states that, if a group health plan or a health insurance issuer provides coverage for eating disorder benefits, the benefits must be consistent with MHPAEA parity requirements.
Eating Disorder Treatment Controversy
Outpatient care for people with serious eating disorders can cost about $100,000 per patient, according to PsychGuides.com. Inpatient care may cost about $30,000 per month. Some patients may get inpatient care for three months to six months, meaning that their bills could total $90,000 to $180,000 per course of treatment.
Insurers have fought major court battles over coverage for inpatient care for eating disorders in California, New York state and other states.
America’s Health Insurance Plans, a group for insurers, has argued that there is no clear evidence that inpatient care does much to help people with eating disorders, or that the more expensive forms of treatment are more effective than cheaper forms of treatment.
Information Disclosure Form
One MHPAEA section, and past tri agency rulings, let patients and providers ask coverage providers for extensive information about all types of behavioral health coverage and coverage decisions.
In the same document the tri agencies used to address eating disorder benefits, the tri agencies announced that they have drafted a voluntary behavioral health benefits information request form.
Patients and providers could use the form to ask for behavioral health benefits information, the agencies say.
The agencies are asking members of the public to look at the draft and send in any comments by Sept. 13.
— Read California Court Makes Insurer Cover Residential Anorexia Care on ThinkAdvisor.