Mental Health Parity and Addiction Act

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Final Rulemaking – MHPAEA

Today, the U.S. Departments of Health and Human Services (HHS), Labor (DOL), and the Treasury are jointly issuing the final rule to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), and ensure that health plan features such as co-pays, deductibles, and visit limits are generally not more restrictive for mental health/substance use disorders benefits than they are for medical/surgical benefits. The final rule will be posted on the Federal Register website by 11:15 a.m. EST.

Today’s action also includes specific additional consumer protections, such as:

Ensuring that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings
Clarifying the scope of the transparency required by health plans, including the disclosure rights of plan participants, to ensure compliance with the law
Clarifying that parity applies to all plan standards, including geographic limits, facility-type limits, and network adequacy
Eliminating an exception to the existing parity rule that was determined to be confusing, unnecessary, and open to abuse.

Billing Code Changes

The US healthcare industry is undergoing a massive change with the adoption and implementation of the ICD-10 (International Classification of Disease, tenth revision) code set effective October 1, 2014. While the mental health industry has historically been “immune” from many of healthcare’s major changes, the ICD-10 transition is an exception. This transition will deeply affect both clinical and revenue operations in behavioral health organizations. We will likely have two codes sets we must rely on for both these operations moving forward: using the DSM-5 for clinical purposes and the ICD-10 for revenue purposes. For more see (may need to cut and paste link into your browser):