ValueOptions® Dr. Ed Jones Answers Questions About Mental Health Parity
The historic legislation of the Mental Health Parity Act makes the equal treatment of mental health and physical health an achievable reality. While this is a great step forward in the delivery of behavioral health care, the legislation raises many challenges for employers and payers who will need to adapt their varied plans. ValueOptions® Senior Vice President/Commercial Division Dr. Ed Jones provides helpful information about how the Mental Health Parity Act affects employer-sponsored group health plans in a series of questions and answers. Jones, a leader in behavioral health care and seasoned advocate for the full integration of mental health and physical health care, recently spoke to more than 100 large and small employers on this issue, including Fortune 100 and 500 companies, and offers his insight and explanation of mental health parity.
"The passage of the Mental Health Parity Act is a major win for the mental health care community — providers, employers and most importantly, those who need and seek care," says Jones  "We have always believed that you have to look at the whole person when defining quality health care. This act puts the person in need at the center of a new continuum of care. Now, employers and plan managers must figure out the best and most effective way to accomplish this."
Jones adds, "To comply with the new legislation, most employers will need to redesign their group health plans. In light of that, it is important for employers to get a head start on incorporating the changes into their benefits structure."
Federal Parity Q&A by Dr. Jones
Question: Should the Mental Health/Substance Abuse (MHSA) benefit cover the diagnoses that are currently covered or should certain diagnoses be excluded to keep costs down?
Answer: Federal parity legislation allows plans to exclude coverage for specific diagnoses or conditions. However, the impact of MHSA disorders on productivity are well-documented, and so cutting health care costs in this way will surely impact the productivity of the workforce in a negative way. Furthermore, while the substance use disorder (SUD) benefits have traditionally been more limited than mental health benefits, the new parity benefit for SUD will not increase costs significantly since ValueOptions® can manage this benefit quite effectively and SUD costs are historically a fraction of the costs for mental health disorders.
Question: Does the parity law apply to employee assistance programs (EAP) and health and wellness benefits?
Answer: The parity law was not written with these benefits in mind, and it is likely that regulations will clarify that these benefits should not be understood as "group health plans" or "health insurance coverage" that is the focus of the law. Until regulatory guidance is available, it is reasonable to assume that the parity law does not apply to EAP and health and wellness programs.
Question: The deductibles and co-payments are higher than we have preferred for the MHSA benefit due to a concern about how these out-of-pocket costs might impact access to care. Do we have to raise the deductibles and co-payments for the MHSA benefit to be on par with the medical plan?
Answer: The federal parity law should be called the parity or "better" law. It is not necessary to exactly match the medical-surgical benefit structure, and it is acceptable to have the MHSA benefit be more generous for employees.
Question: Is it required to have all health care costs for medical-surgical and MHSA care applied to the same annual, lifetime and deductible limits?
Answer: The parity law is vague on this, and so the current practice is assumed to be acceptable of using the same or separate but equal limits. In other words, it is acceptable to either apply all health care costs to a combined limit for annual and lifetime care, or to apply medical and MHSA costs to separate but equal limits/deductibles.
Question: The parity law states that MHSA benefits must include out-of-network coverage if such benefits are included as part of the medical benefit. Can out-of-network care be managed under the parity law or is it an unmanaged benefit?
Answer: MHSA benefits are provided in the law according to "the terms and conditions of the plan," and the out-of-network benefit must be consistent with this requirement. That is to say that the plan can require management protocols (e.g., utilization review, adherence to practice guidelines, adherence to medical necessity criteria) under the terms and conditions of the plan, and these management protocols can be applied to both in-network and out-of-network providers.
"The new law goes into effect January 1, 2010, and though it may seem far off, the changes it requires are substantial," explains Jones. "Employers need to start planning now to understand and implement them into their group health plans."
We invite you to return soon for updates about this important topic.
About Dr. Ed Jones
Dr. Jones has more than 25 years of experience in behavioral health care, including nine years with PacifiCare Behavioral Health. Before joining PacifiCare, Jones was the co-owner and co-director of the Center for Behavioral Healthcare in Los Angeles, a multidisciplinary group practice. Jones also spent 10 years in private practice in Los Angeles, providing cognitive behavioral therapy, chemical dependency treatment, adolescent treatment and psychological assessment. He is currently a member of the editorial board of Behavioral Healthcare magazine.