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Colorado Advanced Practice Psychiatric Nurses

ACA Parity

Posted about 3 years ago by Linda Dwyer

The ACA solidified the full mental health parity promise that came with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).   Now, because mental health services including treatment for substance use disorders are part of the essential health benefits that small group and non-group (individual) insurance plans must cover, they must also cover them with parity to the preponderance of medical services.

The Essential Health Benefits are 10 "domains" that each plan must cover, but the specific benefit configuration and benchmark is left up to states.  States have a benchmark plan (most commonly the 2nd largest small group plan in the state) to determine the threshold for how benefits within each broad category or domain is covered.  If the benchmark plan is missing a domain – or it doesn't live up to other federal regulations (i.e. mental health parity) the state is supposed to supplement the benchmark to get it to minimal standards.

The Center for Consumer Information & Insurance Oversight (CCIIO) issued the 51 benchmark and supplementation plans last month and offered a 30 day comment period for consumers and other advocates to respond to ensure the plans meet the needs of consumers.  For instance, the Florida Benchmark does not include habiliative services or appliances, does not include mental health parity, and contains some other discriminatory language not compliant with the ACA.  He 30 day comment period ends on September 30.

It may be helpful to Psychiatric nurses to enter comments about ensuring that CCIIO supplement the plans with mental health parity statements and that CCIIO provide oversight to assist state regulators in states where the office of the Insurance Commissioner may not be providing adequate oversight and enforcement.

The website for more information is https://www.cms.gov/CCIIO/Resources/Data-Resources/ehb.html#Essential%20Health%20Benefits%20Benchmark%20Plans

The website states: Public comments will be accepted until 11:59 p.m. EDT on September 30, 2015. Please submit comments electronically to FFEcomments@cms.hhs.gov with the state clearly identified in the subject line (e.g., "Maryland 2017 Benchmark Plan Comments"). HHS will review all comments and then post the list of final 2017 EHB benchmark plans.


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