Parity Regulations Out, but So Is Parity`s Champion

The snopocalypse/snowmaggedon/snoverkill that froze (so to speak) the federal government for the past week came sandwiched between two hugely significant chapters in the ongoing struggle for insurance parity for people with mental illness or addiction.

I.

The first was the Feb. 2 publication of the "interim final rules" for the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. Although Schoolhouse Rock and civics classes generally emphasize the legislative process ("how a bill becomes a law"), fewer people are familiar with the regulatory process ("how a law is implemented in the real world"). There are good reasons for this: if you think the legislative flowchart can be confusing, look at the regulatory one. But the reality is that for many laws, the regulatory process can have a huge impact on the degree to which a piece of legislation actually creates change in the real world.

The Wellstone-Domenici Parity Act generally required that insurance plans not offer treatment limitations or financial requirements that are more restrictive for MH/SUD than for medical/surgical benefits. But, as you can imagine, that raises more than a few questions. What types of benefits are included? What do MH/SUD benefits have to be at parity with, exactly? What counts as a MH/SUD benefit in the first place? All of these questions were left largely unanswered in the legislative language, and thus it was up to the regulation writers--in the case of parity, the Departments of Health & Human Services, the Treasury, and Labor--to apply the law to real-world situations.

Delayed in part by uncertainty surrounding the health reform process, parity regulations were supposed to have been issued by October 2009 (as the legislation instructed), and if not then by January 2010 (when the Wellstone-Domenici bill actually went into effect). So it was a great relief to parity advocates when regulations were finally released this month. These regulations go into effect for plan years starting after July 1, 2010 (i.e. January 2011 for plans on a calendar year).

I would echo the response of many other parity advocates in saying that the regulations are, on the whole, good for consumers and providers. There are certainly some limitations (that trace back to the political compromises that were necessary to pass the bill in the first place), but the regulations generally take the spirit of the law into account and move the bill in that direction on issues that could have gone either way.

A detailed summary of the parity regulations can be found by clicking here.

The Departments will accept comments (here) until May 3. However, it's likely that these interim final rules will be the only ones that are issued in the near future.

II.

The second is that today, one of the legislative champions of parity, Rep. Patrick Kennedy (D-R.I.) announced he would not seek re-election in 2010. This means that just two years after the historic passage of the Wellstone-Domenici Parity Act, the five principle sponsors of the law will all be out of Congress: Sen. Ted Kennedy (deceased), Sen. Pete Domenici (did not run in 2008), Sen. Chris Dodd (will not run in 2010), Rep. Ramstad (did not run in 2008), and now Rep. Kennedy.

Kennedy's district was being targeted by Republicans, but he was still almost certain to be re-elected, given his significant fundraising advantage and the fact that Democrats overwhelmingly outnumber Republicans among Rhode Island voters. He did not give a reason why he was stepping down.

Here's the video that Patrick Kennedy has made announcing his retirement from Congress:



With the loss of Rep. Kennedy, it's incumbent on all addiction professionals to advocate with their members of Congress to champion substance use disorder treatment issues. There threatens to be a dangerous void in Congress ...