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Final rule on mental health and addiction parity act is expected Friday

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Rep. Patrick Kennedy: “There are huge consequences to this lack of clarification and implementation of the final rule.”

A much-awaited final rule to implement the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act is likely to come on Friday, U.S. Rep. Patrick Kennedy said during testimony today before a Senate subcommittee hearing.

“There are huge consequences to this lack of clarification and implementation of the final rule,” particularly for veterans, said Kennedy, D-RI, in an impassioned plea to the members of the Senate Judiciary Subcommittee on Oversight, Federal Rights, and Agency Action. “As they go back to work and they are trying to deal with the confusion, with the emotional swings, with the impact and the symptoms of their signature wound of war [traumatic brain injury and PTSD], they need to be assured by all of us that they’re not going to be left behind.

“The notion that we had to wait this long for clarity means that people have fallen through the cracks,” Kennedy said. “We’re going to get a final rule, and I understand it’s going to be tomorrow. But this is not the final rule, it’s the first step” in implementation, he said.

‘True to my dad’s legacy’

“I feel like it’s time, and I feel it’s true to my dad’s legacy,” said David Wellstone, son of the late U.S. Sen. Paul Wellstone, who helped shepherd the bill to final passage.

Wellstone was en route to the 29th Annual Rosalynn Carter Symposium in Mental Health Policy in Atlanta, Georgia, where U.S. Health and Human Services Secretary Kathleen Sebelius is expected to announce the final rule Friday morning.

“It looks like we got everything we’ve been battling to keep in the final rule,” Wellstone said, “including scope of service, intermediate levels of care, transparency, and a commitment to deal with managed care for folks on Medicaid.”

Wellstone, who pushed for passage of the parity law for eight years after his father’s death, was thrilled for longtime parity champion Former First Lady Rosalynn Carter. “I know this is her crowning glory,” he said. “It’s time to turn the page. It’s the next chapter on mental health. And there are battles ahead,” he said.

‘It’s high time’

Former U.S. Rep. Jim Ramstad, R-Minn., said by phone earlier in the day: “It’s high time we treat disease of the brain the same way we treat diseases of the body. The insurance companies have gotten by for too long with their discriminatory practices.”

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was signed into law by President George W. Bush in 2008. 

The law seeks to end discrimination against those who need treatment for addiction and mental illness by requiring employers’ large group plans that do offer such coverage to provide the same level of care and benefits (including deductibles, co-payments, and maximum allowable visits) as they do for other medical conditions. The 2008 law was written to correct a previous version of the law, which did not include treatment for addiction and contained multiple loopholes and serial sunset provisions.

Obamacare extends the law further

The 2010 passage of the Affordable Care Act extends the law further by requiring that insurers participating in the exchange, as well as some small employers and individual plans, also offer coverage for mental health and addiction. (Minnesota has its own parity law for mental health and substance use disorders, which is considered among the strongest in the nation. But it is limited to commercially sold health insurance plans and not “self-insured” plans, which are underwritten by employers and cover about 37 percent of the state’s population.)

Since 2008, “interim” federal rules and regulations have left the parity law open to interpretation, and advocates have been waiting (and waiting) for the Obama administration to issue final rules on the full scope of services that insurers must provide.

“Justice delayed is justice denied,” said Subcommittee Chairman Sen. Dick Blumenthal as he convened today’s hearing.

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