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The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act Understanding the New Federal Parity Law  Healthcare Visions, Inc.  Ronald E. Bachman FSA, MAA [email_address] 404-697-7376 Creating the Possible …
What is  Mental Health and Substance Use Parity? 1.  Equal Benefits : Mental health and substance use parity means that benefits coverage for mental health and substance use  benefits must be at least equal  to that coverage provided for physical health benefits.  2.  Equal Limits : In other words,  all of the financial requirements and treatment limitations  applied to mental health and substance use benefits may be no more restrictive than for physical health benefits.  3.  Equal Cost-sharing : Historically, health plans have applied  higher patient cost-sharing  and  more restrictive treatment limitations  to mental health and substance use benefits than for physical benefits.  This new law ends this practice.
What does the New Federal Parity Act Do? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How is this New Parity Law different from the 1996 Federal MH Parity law? ,[object Object],[object Object],[object Object]
When does this New Parity Law take Effect? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Which Health Plans will have to Comply with the New Parity Law? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Does the Wellstone-Domenici Parity Act apply to Medicare and Medicaid patients? ,[object Object],[object Object],[object Object],[object Object]
What Diagnoses are Included  for Parity Protection? ,[object Object],[object Object],[object Object]
Can a Diagnosis be Excluded from coverage under the New Parity Law? ,[object Object],[object Object],[object Object],[object Object]
Does this New Parity Law have any impact on benefits management and medical necessity criteria? ,[object Object],[object Object]
Does the Wellstone-Domenici Parity Act apply to the out-of-network (OON) services that I provide? ,[object Object],[object Object],[object Object],[object Object]
Does the Wellstone-Domenici Parity Act impact network reimbursement? ,[object Object],[object Object]
Can health plans drop MH/SA benefits completely to avoid the new law? ,[object Object],[object Object],[object Object],[object Object]
My state already has a Parity Law.  How will this new federal law impact state law? ,[object Object],[object Object],[object Object],[object Object]
How Will the New Parity Law be Enforced? ,[object Object],[object Object],[object Object]

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Understanding the New Federal Parity Law 

  • 1. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act Understanding the New Federal Parity Law  Healthcare Visions, Inc. Ronald E. Bachman FSA, MAA [email_address] 404-697-7376 Creating the Possible …
  • 2. What is Mental Health and Substance Use Parity? 1. Equal Benefits : Mental health and substance use parity means that benefits coverage for mental health and substance use benefits must be at least equal to that coverage provided for physical health benefits. 2. Equal Limits : In other words, all of the financial requirements and treatment limitations applied to mental health and substance use benefits may be no more restrictive than for physical health benefits. 3. Equal Cost-sharing : Historically, health plans have applied higher patient cost-sharing and more restrictive treatment limitations to mental health and substance use benefits than for physical benefits. This new law ends this practice.
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