Photo by Nik Shuliahin on Unsplash

Here are upcoming changes in the way Aetna pays certain Behavioral Health outpatient benefits. Upon plan renewal on or after January 1, 2018, the following Behavioral Health services will be classified as behavioral health outpatient “all other” for purposes of Federal Mental Health Parity law:

  • Partial hospitalization programs (PHP)
  • Intensive outpatient programs (IOP)
  • Applied behavior analysis (ABA) for the treatment of autism spectrum disorder (may be an excluded benefit for self-insured customers)
  • Home health care
  • Transcranial magnetic stimulation
  • Electroconvulsive therapy (ECT)
  • Vagus nerve stimulation (normally an excluded benefit)
  • Outpatient monitoring of injectable therapy
  • Psychological testing
  • Neuropsychological testing
  • Medical treatment for withdrawal symptoms
  • Outpatient detoxification
  • Ambulatory detoxification
  • 23-hour observation

Federal law requires Aetna to make sure coverage of mental health and substance abuse services is in parity with coverage of medical and surgical services. As part of an ongoing review, Aetna decided to classify the outpatient mental health/substance use benefits above as “outpatient – all other,” rather than “outpatient – office.” This decision reflects that each service:

  • Includes some type of technological or physical intervention, or
  • That they’re traditionally delivered outside an office setting, like in the home

As a result, these benefits will be subject to the cost share for “outpatient – all other” treatments, rather than that applied to “outpatient – office” treatments.

Changes for self-insured customers are as follows:

Related posts