Vermont court rules in favor of patient in Mental Health Parity case

Jul 29, 2013

By Paul R. Pace, News staff

The Mental Health Parity and Addiction Equality Act of 2008 still awaits a final federal rule to implement the law.

However, progress was made for patients’ rights on April 30 when the U.S. District Court for the District of Vermont gave its interpretation of the law in the case C.M v. Fletcher Allen Health Care.

According to the American Psychiatric Association, the ruling found in favor of a patient who alleged her health plan violated the MHPAEA.

Colleen Coyle, general counsel for the APA, said in a news release that the ruling is significant because “it clearly puts the burden on the insurance industry to provide clinically appropriate standards of care to justify treating mental health claims differently than medical-surgical claims.”

In denying a motion to dismiss, the court stated, “The Parity Act and its regulations impose the burden upon the plan administrator to provide plan participants and beneficiaries with the criteria for medical necessity determinations, an explanation for any denial of reimbursement or payment for services, and the reasons for claim denial.”

Coyle added, “Mental health and substance disorder patients have a right to know whether they are being treated differently than patients with other physical or surgical issues, and if so, on what clinical grounds the insurance companies justify that difference.”

NASW has been a strong supporter of the act, advocating for its passage into law.

Earlier this year, the association sent out an advocacy alert that highlights the urgency for a final federal rule implementing the law. It is available at .

The alert encourages social workers to contact the U.S. Departments of Labor and Health and Human Services to share their stories of witnessing parity violations so that such practices can be prohibited in the final rule.

The NASW Legal Defense Fund has also published a parity article that summarizes the pertinent provisions of the interim final rule: .

The Mental Health Liaison Group, of which NASW is a member, will continue to monitor the implementation of the Parity Act and advocate for the issuance of final regulations, said Sherri Morgan, associate counsel of the NASW LDF and Office of Ethics and Professional Review.

From the July 2013 NASW News

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