Thursday, May 20, 2010

American Psychological Association Weighs In re: MH Parity Law Battle Looming

Date: May 17, 2010

To: SPTA and Division Federal Advocacy Coordinators
APAGS Coordinators

From: Marilyn Richmond, J.D., Assistant Executive Director for Government Relations
American Psychological Association Practice Organization

Cc: Katherine Nordal, Ph.D., Executive Director for Professional Practice
SPTA Executive Directors
SPTA Directors of Professional Affairs

Re: Update on Regulatory Implementation of Federal Parity Law

On February 2 the Departments of Health and Human Services, Labor and Treasury (the Departments), published an interim final rule (IFR) to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). The American Psychological Association Practice Organization (APAPO) supports the IFR, as published, and has urged the Departments to ensure its final implementation. This Information Alert provides information about the IFR, APAPO’s efforts in seeking its final implementation, and a legal action that a group of managed behavioral health organizations (MBHOs) has brought to prevent the implementation of the IFR.

MHPAEA was enacted into law on October 3, 2008, and became effective on October 3, 2009. The law, however, requires the Departments to promulgate regulations that detail compliance with its provisions. Health plans have complied with the law since October 3, 2009, based on their assessment of its requirements. The IFR will generally apply to health plans for plan years beginning on or after July 1, 2010, which means that most plans will have to begin complying with the IFR beginning January 1, 2011.

The IFR fully implements the statutory requirements of MHPAEA by requiring parity for all financial requirements and treatment limitations. The regulation also prohibits the imposition of separate deductibles and out-of-pocket maximums as applied to mental health and substance use disorder benefits and requires parity for “nonquantitative” treatment limitations, such as those related to benefits management. It is anticipated that the Departments will make the rule final at some point later this year after considering comments on the IFR, which were due on May 3. The Departments may make changes to the IFR before finalizing it, based on comments received.

As mentioned, APAPO fully supports the interim rule, as published, and has taken a lead in supporting the Departments in the rulemaking process leading to final implementation. On May 3, APAPO filed comments in support of the rule, as published, emphasizing the importance of applying parity to prohibit separate deductibles and related cost sharing and for the implementation of the law as it applies to nonquantitative treatment limitations, including benefits management. APAPO also wrote and garnered signatures for the Mental Health Liaison Group (MHLG) comments in support of the parity interim rule. The MHLG is the most significant mental health and substance use coalition in Washington, DC. Through APAPO’s efforts, 55 national organizations signed their support for the IFR—the most signatories for any MHLG letter in its long history. Both APAPO’s comments and the MHLG comments in support of the IFR will be made available on the Department of Labor’s website in the coming weeks at

APAPO’s efforts have taken on greater significance since April 1, when a group of MBHOs sued the Departments, asking the US District Court for the District of Columbia for a temporary restraining order (TRO) to block the rule and for a preliminary injunction to stop the rulemaking process from moving forward. The MBHOs argue that the Departments violated federal rulemaking procedure in publishing the rule as they did. They also argue that the Departments overstepped their rulemaking authority by interpreting the statutory language of the MHPAEA to prohibit separate deductibles and to require parity for nonquantitative treatment limitations, specifically as related to benefits management. On April 4 the court denied the TRO and said that it would hear the case regarding issuance of an injunction. The court is expected to hear the request for an injunction shortly in the coming weeks. The court has denied a motion that would allow outside parties to submit amicus curiae briefs and will hear the case as presented only by the parties to the action. While federal regulatory agencies enjoy wide discretion in their rulemaking authority, should the MBHOs prevail, the rulemaking process could be altered and ultimately changes could be made to the rule before it becomes final.

APAPO will keep practitioners informed as the regulatory process moves forward.

Sallie E. Hildebrandt, Ph.D.2010 CPA President Elect4130 La Jolla Village Dr., Ste 301La Jolla, CA 92037Phone: 858-453-1800 FAX: 858-452-3992Email:


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1:44 PM  
Anonymous Anonymous said...


11:54 PM  
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12:32 AM  

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