While an interim rule on mental health parity was met with mostly positive reviews, a coalition is suing saying the proper process wasn’t followed in issuing the rule
An interim rule that implements a parity law requires some group health plans that provide medical-surgical coverage and mental health and substance-abuse coverage benefits to ensure that financial requirements and treatment limits for both are equal. Michele Gougeon of McLean Hospital, left, says, “It’s pretty clear what the legislation wants is real parity.” However, a coalition is suing over the way the rule was issued.
Typically a dry and tedious endeavor, the federal rulemak-ing process has gotten a little more interesting for mental health parity advocates in the past few weeks. Behavioral healthcare providers, managedcare organizations and associations are still interpreting the federal government’s interim final rule for mental health parity legislation that became effective April 5 as they prepare for a public-comment deadline in early May.
The rules and regulations—issued by HHS and the Labor and Treasury departments on Feb. 2—apply to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, which Congress passed on Oct. 3, 2008. A hard-fought victory for behavioral health advocates, the law requires group health plans with 50 or more employees that provide medical-surgical coverage and mental health and substance-abuse coverage benefits to ensure that financial requirements and treatment limits for both are equal (Oct. 6, 2008, p. 6). Although the regulations went into effect last week they will apply to plan years beginning on or after July 1.
In early April—one month before the rule’s public-comment deadline—the Coalition for Parity, a group of three managed behavioral healthcare organizations, sued HHS Secretary Kathleen Sebelius, Labor Secretary Hilda Solis, Treasury Secretary Timothy Geithner, and their respective Cabinet departments, for what they contend was the departments’ failure to “engage in required notice and comment rulemaking” before the interim final rules were issued.
At issue, the plaintiffs argue, is that the three departments failed to issue a proposed rule by Oct. 3, 2009 (the one-year anniversary of the bill’s passage), choosing instead to issue an interim final rule.
“The coalition and its members advocated for and fully support the parity statute,” said Jeffrey Poston, a partner at Crowell & Moring in Washington and lawyer for the coalition, which consists of Magellan Health Services, ValueOptions and Beacon Health Strategies.
“The lawsuit is about due process. The coalition seeks only to participate in the rulemaking process and provide input to help fashion the best possible regulations and safeguard access to quality behavioral healthcare.”
According to the Feb. 2 Federal Register, proposed rulemaking “is not required when an agency, for good cause, finds that notice and public comment thereon are impracticable, unnecessary or contrary to the public interest.”
Meanwhile, providers, associations and insurers continue to pore over the interim final rule as they prepare to submit comments. For some, the response to the regulations was positive. “This particular regulation has been very thoughtfully crafted,” said Michele Gougeon, executive vice president and chief operating officer at 177-bed McLean Hospital in Belmont, Mass., which is affiliated with Harvard Medical School. Gougeon also said there was consistency in the structuring of the rule. “It’s pretty clear what the legislation wants is real parity between mental and substance-abuse services and general medical services.”
According to a summary from the CMS, the act preserves the protections of the Mental Health Parity Act of 1996, which states that a group health plan may not impose annual or lifetime dollar limits on mental health and substance-use-disorder benefits that are less favorable than any limits imposed on medical-surgical benefits.
The new act, which applies to commercial health plans and Medicaid managed-care plans, Anecdotal evidence suggests the new law has increased patient volume at behavioral health providers.