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The Paul Wellstone and Pete Domenici Mental Health Parity & Addiction Equity Act

The Paul Wellstone and Pete Domenici Mental Health Parity & Addiction Equity Act Presentation by Andrew Sperling Director of Legislative Advocacy NAMI National andrew@nami.org February 25, 2009. First, A Little History …. May 1992 – first federal bill introduced – S 2696

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The Paul Wellstone and Pete Domenici Mental Health Parity & Addiction Equity Act

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  1. The Paul Wellstone and Pete Domenici Mental Health Parity & Addiction Equity Act Presentation by Andrew Sperling Director of Legislative Advocacy NAMI National andrew@nami.org February 25, 2009

  2. First, A Little History … • May 1992 – first federal bill introduced – S 2696 • 1993 & 1994 – Clinton Health Care Reform, standard minimum federal benefit with discriminatory limits • April 18, 1996 – Amendment to HIPAA legislation passes Senate 68-30 • September 22, 1996 – Domenici-Wellstone Amendment signed in to law as part of FY 1997 VA-HUD Appropriations bill, parity for annual and lifetime dollar limits only • 1996 – parity enacted in only 6 states (MD, MN, NH, RI, NC & TX state employees; by 2000, more than 25 states have enacted parity, including AL, CA, IN, NJ, SC & TX • June 1997 – Parity requirement added to Senate SCHIP bill, then dropped in House-Senate conference

  3. Efforts in Congress Continue … • June 9, 1999 – President Clinton signs Executive Order requiring parity for all FEHBP plans – 9.5 million covered lives – becomes model for all future federal parity proposals • October 30, 2001 – Senate adopts parity amendment to the FY 2002 Labor-HHS Appropriations bill • April 30, 2002 – President Bush endorses parity at the University of New Mexico • October 25, 2002 – Senator Wellstone dies in plane crash • 2006 – Negotiations commence with employers and health plans, Senator Enzi plays a key role

  4. Efforts in Congress Accelerate … • February 14, 2007 – S 558 reported by the Senate HELP Committee • September 18, 2007 – Senate passes parity bill (S 558) by unanimous consent after disputed language on state preemption is removed • March 6, 2008 – House passes parity (HR 1424) by a vote of 268-148 – after clearing 3 separate House Committees • Late June 2008 – agreement reached by all parties, budget offsets needed • October 3, 2008 – Parity attached to financial market recovery legislation and signed in to law

  5. Parity in Group Health Plans • P.L. 110-343, signed on October 3 • Attached to the financial market rescue and tax extenders legislation • Becomes effective in new group health plan years starting after October 3, 2009 • Requires equity in coverage with respect to: • Durational treatment limits (caps on inpatient days and outpatient visits) • Financial limitations (higher cost sharing, deductibles, out-of-pocket limits)

  6. Questions? www.nami.org andrew@nami.org

  7. What You Need To Know About The New Mental Health And Substance Abuse Insurance Parity Law February 25, 2009 Pamela Greenberg, MPP President and CEO Association for Behavioral Health & Wellness

  8. Agenda • Paul Wellstone & Pete Domenici Mental Health Parity & Addiction Equity Act • Next Steps -- Regulations

  9. Who Does The New Law Apply To • Group Health Plans and Health Insurers That Provide Coverage to Group Health Plans (employers with over 50 employees) • Medicaid Managed Care Plans • State Children’s Health Insurance Program • Non-Federal Governmental Plans • Federal Employees Health Benefits Plans

  10. Summary of the Law • Benefits Covered • Mental Health Conditions • Substance Use Disorders • Parity Requirement • Financial Requirements • Treatment Limitations

  11. Summary of the Law Continued • Out-of-Network Benefits • Management • Transparency • Small Employer Exemption • Cost Exemption • Compliance Report • GAO Study • Consumer Assistance • Enforcement/Regulations • State Laws • Effective Date

  12. What’s Next • Departments of Labor, Health and Human Services and Treasury to Issue Regulations 1 Year After the Date of Enactment • RFI – Comment Period; Proposed Rule & Comment Period (?); & Final Rule

  13. Areas That May Need Clarifications in Regulations • Define No More Restrictive than the Predominant Financial/Treatment Limitations Applied to Substantially All Medical and Surgical Benefits • Preemption of State Laws

  14. Areas That May Need Clarifications in Regulations Con’t. • Management of the Benefit • Cost Exemption • Separate But Equal Deductibles • Does the Law Apply to EAPs • Parity Means Equal to or Better than

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