Managed Healthcare Executive - March 2009 - (Page 23) { HEALTH MANAGEMENT } Parity law stirs up the question of what constitutes parity New federal law prompts self-insured organizations, once exempt under ERISA, to rethink mental-health bene ts BY SHELLY REESE Shelly Reese is a freelance writer based in Cincinnati, Ohio. provide the same nancial and treatment coverage that they o er for physical illnesses. It does not require group plans to provide mental-health coverage. The federal government started moving toward parity in 1996 when it passed legislation requiring parity coverage for annual and lifetime dollar limits. It continued down that road in January 2001, when the Federal Employees’ Health Bene t (FEHB) Program adopted parity requirements preventing health plans from applying higher patient cost-sharing and lowering day/visit maximums for mental health and substance abuse services compared to services for physical illness, injury or disease. The new legislation builds on the 1996 law and expands parity by requiring equality for deductibles, copayments, outof-pocket expenses, coinsurance, covered hospital days, and covered outpatient visits. It applies for plan years beginning after October, although sponsors of collectively bargained plans have until Jan. 1, 2010, or the rst plan year after the bargaining year terminates. N OCT. 3, 2008, CONGRESS sent a clear The change does not a ect everyone. message to employers: If you o er mental- For example, the mandate does not apply health bene ts, they must be on par with to companies with fewer than 50 emyour medical bene ts. ployees or to companies that do not o er For many employers, the legislation passed un- mental-health bene ts. Similarly, large noticed. For self-insured organizations, which fall employers who use third-party adminisunder ERISA and are therefore exempt from state trators are already required to meet myrimandates, however, the federal legislation means ad state parity mandates and requirements, rethinking the way they approach mental health some of which are even more stringent bene ts. then the new federal legislation. The Mental Health Parity and Addiction Equity “The new federal parity law is an e ort Act, which ultimately came wrapped in the Emer- to have parity legislation apply to comgency Economic Stabilization Act, requires health panies that are national in scope that had insurance plans that o er mental health coverage to been exempt under ERISA,” explains Stockbyte/Getty Images O MARCH 2009 23
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