The Therapist 
November/December 2008

On October 3rd, Congress passed, and President Bush signed, the Paul Wellstone and Pete Domenici Mental Health Parity & Addiction Equity Act of 2008. This bipartisan legislation will help put an end to discrimination against patients seeking treatment for mental illness and addiction. It will amend Section 712 of the Employee Retirement Income Security Act of 1974, Section 2705 of the Public Health Service Act, and Section 9812 of the Internal Revenue Code of 1986.

The passage of this historic piece of legislation has been a long time in coming. Beginning in 1996, Senator Paul Wellstone took up the cause to ban plans from setting lower spending limits for mental health treatments. This cause stemmed from a young anorexic woman who committed suicide after being denied coverage for her condition. Senator Wellstone teamed up with Senators Pete Domenici and Edward Kennedy, as well as Representatives Patrick Kennedy and Jim Ramstad to fight what became a lengthy battle for equal treatment of mental health and physical health disorders.

Over the last twelve years, hundreds of mental health advocacy groups, coalitions, and associations, including CAMFT, have been fighting in Washington D.C. for parity in mental health. In March 2008, the CAMFT Board of Directors stood on Capital Hill and participated in a rally supporting this piece of legislation. Through determination, grass roots efforts, and a sense of priority in both Democrat and Republican Congressional advocates, this important piece of legislation finally passed and was signed.

What Does This Legislation Do?
The major components of this legislation are:

• Treatment Equity: Prohibition of insurers and health plans from imposing treatment limitations on mental health benefits that are more restrictive than those applied to medical services––for example, frequency of treatment, number of visits, and days of coverage.
• Financial Equity: Prohibition of insurers and health plans from imposing financial limitations on mental health benefits that are more restrictive from those applied to medical services––or example, deductibles, co-payments, co-insurance, and out of pocket expenses.
• Out of Network: Plans that offer outof- network benefits must offer out-ofnetwork benefits on the same terms for mental health services as they do for medical and surgical services.

Currently, the California parity law demands that the following conditions be covered by mental health service plans: schizophrenia; schizoaffective disorder; bipolar disorder; major depressive disorders; panic disorder; obsessive-compulsive disorder; pervasive developmental disorder or autism; anorexia; bulimia; and, serious emotional disturbances of children. This federal legislation will mandate that health insurance plans that have mental health components additionally now cover substance abuse, as well as any mental health disorder (for example, attention deficit disorder and generalized anxiety disorder).

Not only does this piece of legislation provide equality between physical and mental health treatment, it provides economic benefit. According to House Speaker Nancy Pelosi, “Untreated mental illness results in 1.3 billion lost days of work or school in our country every year.” Moreover, according to the Wall Street Journal, addiction and mental illness cost our economy $550 billion last year, and $70 billion was lost from our economy because of untreated depression alone. This legislation is a first step in providing money back into the economy, which had been lost due to the inequality in mental health services.

Who Does This Legislation Apply to?
This legislation will apply to: 1) employers with more than 50 employees; and, 2) selfinsured or self-funded employers (meaning large employers who cover the financial costs of health care in-house). In California, employers with 50 or fewer employees will not need to comply with this newly passed legislation. This past September, Governor Schwarzenegger vetoed similar state legislation (AB 1887) which would have mandated all employers expand coverage to provide equality for both physical and mental health disorders.

When Does This Legislation Become Law?
This legislation will become effective January 1, 2010. Because health plans and insurers, as well as employers, are being mandated to revamp their procedures, policies, and coverage systems, this extended date allows the time to comply with the new, more expansive, law.

What Does This Mean for Marriage and Family Therapists?
MFTs are affected by this legislation the same as Psychologists, Social Workers, and Psychiatrists. This is not legislation that affects the scope of practice of MFTs, or that expands the current laws surrounding MFTspecific reimbursement. This legislation exclusively speaks to the expansion of coverage requirements for certain health care service plan contracts and health insurance policies, requiring them to include substance abuse and the diagnosis and treatment of mental illness. This is a huge victory for people affected by substance abuse and mental health disorders. CAMFT thanks all of our members who reached out to their elected Congressional Representatives to let them know the importance of ending health coverage discrimination against persons with mental illnesses.

Catherine L. Atkins, J.D., is a Staff Attorney at CAMFT. Cathy is available to answer members’ questions regarding business, legal, and ethical issues.

This article appeared in the November/December 2008 issue of The Therapist, the publication of the California Association of Marriage and Family Therapists, headquartered in San Diego, California. This article is intended to provide guidelines for addressing difficult legal dilemmas. It is not intended to address every situation that could potentially arise, nor is it intended to be a substitute for independent legal advice or consultation. When using such information as a guide, be aware that laws, regulations and technical standards change over time, and thus one should verify and update any references or information contained herein.