Sebelius noted that in response to a call for public comment about how best to formulate rules governing coverage of mental health issues by group health plans in April (see Feds Ask for Help on Mental Health Coverage Rules ), the department received more than 400 written comments. “HHS has been carefully evaluating the comments, along with the Department of Labor and the Department of the Treasury, as we concurrently develop the regulations needed to implement the statutory requirements,” Sebelius wrote.
Sebelius’ letter was in response to a September 23 letter from Congress urging Sebelius, Labor Secretary Hilda Solis and Treasury Secretary Timothy Geithner to issue the guidance as soon as possible. The letter reminded the regulators that the deadline for guidance was one year after enactment of the parity law, which would have been on October 3 (see Mental Health Parity Measure Tacked onto Wall Street Aid Bill ).
The law requires group health plans for businesses with 50 or more employees to provide coverage for mental health and substance abuse disorders that is no less restrictive than coverage for other medical conditions.
“[W]e are hopeful that the promulgated regulations will clearly reflect Congressional intent,” the letter said. Lawmakers pointed to several important issues, including:
- “Scope of services: It is the intent of this legislation that patients have access to the full scope of services, medically-appropriate for their condition. Regulations should clarify that patients have access to the full scope of services for mental health and substance use disorders which are medically-appropriate;
- “Medical management: It is the intent of this legislation that plans retain the right to medically manage mental health and substance use disorder benefits, so long as the medical management criteria, including application of scientific research criteria, is no more restrictive than for medical/surgical benefits;
- “‘Separate but equal’ is not parity: Separate deductible caps for medical/surgical benefits and mental [benefits] present a significant barrier to treatment, is discriminatory and should be prohibited;
- “Treatment limitations: The refusal of plans to reimburse medically appropriate mental health/substance use disorder treatments is a violation of the ‘treatment limitations’ definition in the Wellstone Domenici Act and should be prohibited; and
- “Timely implementation: Timely implementation of the regulations is critical to avoid continued health discrimination of those with mental health and substance use disorders.”
The letter from lawmakers is here .
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