New York State Out In Front on Mental Health Parity

New York Attorney General Eric Schneiderman recently settled with Excellus, a Rochester-based health plan, to ensure it covers mental health and substance use disorder (MH/SUD) treatment for its 1.5 million members. Schneiderman has taken an aggressive approach to enforcing state and federal mental health parity laws; this was the fifth settlement by his office since last year.

The federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is intended to align insured health care benefits for MH/SUD with those for medical and surgical care. The MHPAEA requires certain group health plans to ensure that financial requirements (e.g., copays and deductibles) and treatment limitations (e.g., visit limits) that are applicable to MH/SUD benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical and surgical benefits. The MHPAEA does not mandate that a plan must provide MH/SUD benefits. Rather, it requires that if a plan provides medical, surgical, and MH/SUD benefits, it must provide them equitably.

According to the Excellus settlement agreement, the plan denied coverage for inpatient mental health and substance use disorder treatment at more than double the denial rate for medical surgical treatment. "Every year, almost one in four New Yorkers has symptoms of a mental disorder," the agreement said, citing state Health Department data. "Lack of access to treatment, which can be caused by health plans' coverage denials, can have serious consequences for consumers, resulting in interrupted treatment, more serious illness and even death."

New York State was an early adopter of mental health parity, passing Timothy’s Law the year before the MHPAEA was enacted. Other states’ enforcement actions, however, are mixed, and application of parity laws generally remains varied across the country. The question is, will New York set a trend for enforcement of the federal law?

Daphne Saneholtz is a partner in the Columbus, OH office of Brennan, Manna & Diamond.