The Paul Wellstone and Pete Domenici Mental Health Parity andAddiction Equity Act of 2008 (MHPAEA) prohibits group health orself-insured plans covering more than 50 employees from imposingcaps or limitations on mental health treatment or substance usebenefits that are not also applied to medical and surgicalbenefits.

Many employers will have to increase the mental health andsubstance abuse (MH/SA) coverage in their existing benefit plans tocomply with the new parity requirements. Employer groups,particularly those that are self-insured, are concerned about theresulting increase in their health care spend.

• Plans without some form of behavioral health management mayexpect increases in outpatient costs of up to 30 percent.(Milliman, 'An Actuarial Analysis of the Impact of HR 1424')

• Estimates of cost increases to employers that are alreadycomplying with comprehensive state mandates range from 1 percent to3 percent or more of total health care costs. (Mercer, 'Guidelinesfor Cost-Effective Implementation of the Mental Health Parity andAddiction Equity Act of 2008')

Over 90 percent of employer-sponsored health plans includecoverage for MH/SA services, according to the Employee AssistanceProfessionals Association (EAPA). Should these employers and plansopt to maintain their mental health and substance abuse benefits,an EAP with an MH/SA Gatekeeper component can enhance the value ofthe program. An effective Gatekeeper benefits both employers andplan participants by redirecting "EAP-appropriate" cases into theEAP at the point of entry, while guiding members with acute mentalhealth or substance abuse needs to the appropriate level of carewithin the benefit plan. As a result, patient care is optimizedwhile health care costs are managed more effectively.

The Gatekeeper service takes direct aim at MH/SA costs in threeways:

• Redirection: The majority of all MH/SA claims are foroutpatient short-term counseling. From the onset of the case,members with short-term counseling needs are guided into the mostappropriate avenue of care, which is usually the EAP. In a5-session EAP model, on average, two-thirds of non-medicationoutpatient counseling cases can be addressed within the frameworkof the program. By providing the right mode of care from the pointof entry, employers benefit by mitigating the financial impact of acase that would have otherwise generated a claim.

• Advocacy: Members with acute MH/SA needs that require inpatientcare, partial hospitalization, medication management or long-termoutpatient services are guided to the most appropriate in-networkcare choices within their benefit plan. An effective MH/SAGatekeeper can reduce out-of-network utilization by over 50percent.

• Guidance: A member may contact the EAP provider to preauthorizea level of care that is inappropriate for his or her condition. Inthese cases, assuming the provider is staffed with licensedbehavioral health clinicians, the member will be guided to the mostappropriate level of care, which often results in a cost savingsfor both the employer and the employee.

Mindee Zis, senior account executive at Allied Benefit SystemsInc., a Chicago-based third party administrator, has seen theimpact of the EAP Gatekeeper model first-hand.