April 2010

New Federal Rules for Behavioral Health Go Into Effect July 1

BlueCross BlueShield of Tennessee has made changes to its behavioral health options to comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) in October 2009. In February 2010, the federal rules enforcing the MHPAEA were issued. Health plans, working with legal counsel and industry groups, are studying the rules, and three federal agencies (IRS, DOL and HHS) are accepting comments until May 3, 2010.

For employers with 51 or more employees, these rules take effect beginning with July 1, 2010, renewals. The federal rules require changes to behavioral health benefits in addition to those made October 2009.

Behavioral Health Benefit Changes

1. Prior authorization. According to the federal rules, prior authorization is considered a non-quantitative treatment limit. Prior authorization cannot be required for behavioral health if it is not required for equivalent medical services. As a result of this rule, the prior authorization requirement for outpatient behavioral health will be removed for groups subject to MHPAEA and renewing on or after July 1, 2010.

2. Having separate medical vs. behavioral health deductibles and out-of-pocket maximums violates the federal rules. BlueCross BlueShield of Tennessee’s standard behavioral health benefits comply with the MHPAEA and the federal rules. But, if your client’s behavioral health benefits are provided by another carrier or behavioral health organization, the plan cannot require separate deductibles for medical and behavioral health under the new rules. The medical and behavioral health benefits must be integrated. This integration requires data exchanges between BlueCross BlueShield of Tennessee and the vendor, and additional fees will apply. Please notify your BlueCross BlueShield of Tennessee sales or account executive if your customer has a behavioral health carve-out arrangement.

3. Employee Assistance Programs cannot act as a gatekeeper. This means a plan cannot require employees to exhaust EAP benefits before accessing behavioral health benefits (unless a similar requirement exists for medical benefits). EAP programs offered through Group Insurance Services comply with MHPAEA.

Click to view the federal rules for Mental Health Parity and Addiction Equity Act.