As part of the recently enacted $700 billion Emergency Economic Stabilization Act of 2008, The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was enacted into law on October 3. The law expands on a law initially passed in 1996 that banned health plans from setting lower annual and lifetime spending limits for mental health treatments. The new law requires that health plans provide equivalent benefits for the treatment of mental illness and substance abuse as they do for other medical conditions.

Specifically the act requires:

• Equity in financial requirements such as deductibles, co-payments, coinsurance and out-of-pocket expenses
• Equity in treatment limits such as caps on the frequency or number of visits, limits on days of coverage or other similar limits on the scope and duration of treatment
• Equity in out-of-network coverage

In addition, several other elements of the new act include:

• Group health plans must comply with the law in plan years beginning on or after Oct. 3, 2009 – for most plans, this will mean the effective date of compliance is on or after January 1, 2010
• The Act applies to employers with more than 50 employees
• Cost exemption provisions contained in the new law may allow an employer to be exempted from the law, if they can document increased total health plan costs of 1% (2% in the first year that this law is applicable) as a result of implementing the provisions of the law

As regulations for this Act have yet to be written, some of the details regarding implementation and administration of the Act are subject to change. Stay tuned.

What Should Self-Insured Employers do to Prepare?
Work with Humana or your consultant to:

• Assess projected financial implications
• Determine what changes you will need to make to be compliant
• Consider implementing a behavioral health management such as Humana’s integrated behavioral health management program
• Determine what changes you might want to make to the structure of your EAP, if offered

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