Parity implementation Coalition Applauds Supreme court ruling and New regulatory Guidance on the Mental Health Parity and Addiction equity Act
WASHINGTON, D.C.—November 20, 2015 —Members of the Parity Implementation Coalition (PIC), a group of addiction and mental health consumer and provider organizations committed to the implementation of the 2008 parity law, applaud two recent developments that provide important new tools to assist plan participants with receiving addiction and mental health benefits as guaranteed under the parity law: a recent Supreme Court ruling and the release of guidance on the Mental Health Parity and Addiction Equity Act by the Departments of Labor, Health and Human Services and Treasury.
On November 16th, in UnitedHealth Group, Inc., et al, v. Jonathan Denbo, et al, the Supreme Court announced it will not review the decision of the Court of Appeals for the 2nd Circuit in New York that found that individuals can sue the entity that manages their care directly rather than their employers or plan sponsors. The Plaintiffs, the New York State Psychiatric Association (NYPSA), Jonathan Denbo and Dr. Shelly Menolascino, sued United on the grounds the health insurer, which administered an ERISA-governed health plan, had violated the Federal Parity Law.United asked that the complaint be dismissed, stating that NYPSA did not have standing and they could not be sued for not following the Federal Parity Law or ERISA.
The Second Circuit Court of Appeals found that NYPSA has standing in the litigation. The court also found that when a claims administrator has total control over benefits claims and makes “final and binding” decisions on appeals of denials, the claims administrator is an appropriate defendant. The Supreme Court’s decision not to review the case means that ruling stands and the case may proceed, which is an important victory for patients as it allows them to seek legal recourse against the plan that makes behavioral health benefit determinations.
Additionally, the PIC applauds the Departments of Health and Human Services, Labor and Treasury for issuing guidance that: 1) underscores that plans must make medical necessity criteria available to current and potential plan participants, 2) reiterates that plans must disclose this criteria regardless of whether that criteria is proprietary or of commercial value, and 3) requires ERISA plans to provide the instruments under which the plan is established or operated to plan participants within 30 days of the request.
“The release of this guidance is particularly important during this open enrollment season while many Americans are having to make decisions about which health plans have the services they need to manage the behavioral health care needs of themselves and their families,” said Irvin “Sam” Muszynski, Co-Chair of the Parity Implementation Coalition.
“Together, the Court ruling and new guidance provide important new tools for plan participants to ensure they can access the addiction and mental health benefits guaranteed under the federal parity law,” said Mark Mishek, President and CEO of the Hazelden Betty Ford Foundation.
Members of the Parity Implementation Coalition are committed to serving as a resource to those in and outside of government for the full implementation and enforcement of the federal parity law.
The Parity Implementation Coalition includes the American Psychiatric Association, Cumberland Heights, Hazelden Betty Ford Foundation, Depression and Bipolar Support Alliance, MedPro Billing, Mental Health America, National Alliance on Mental Illness, National Association of Psychiatric Health Systems, National Association of Addiction Treatment Providers, The Watershed Addiction Treatment Programs and Young People in Recovery.The organizations advanced parity legislation and implementing regulations for over fourteen years in an effort to end discrimination against individuals and families who seek services for mental health and substance use disorders and remain committed to its effective implementation.More information about the Coalition is available at www.parityispersonal.org.