1. FEDERAL MENTAL HEALTH PARITY SLEEPLESS IN SAINT LOUIS Peter A. Ambrose, Jr., Ph.D., M.B.A. Regional Vice President, WellPoint Behavioral Health Operations

2. CONSIDERATIONS Covered Diagnoses Treatment Limits; Financial Limits Specialist / Non-Specialist Designation Clinical Management Strategies Operational Implementation Cost of Care Implications

3. COVERED DIAGNOSES Act does not mandate coverage. Act does not mandate coverage of all Mental Health conditions. State mandates may have specific guidance. Intention of defined eligible diagnoses should be vetted.

4. TREATMENT LIMITS; FINANCIAL LIMITS Treatment Limitations – can’t be more restrictive than the “predominant” treatment limits applied to medical, with no separate treatment limitations. Financial Requirements may not be more restrictive than “predominant” financial requirements applied to medical. Can MH/SA be better? Are there comparable treatment modalities/service levels? –RTC vs. SNF? –IOP/PHP vs ???

5. SPECIALIST / NON-SPECIALIST DESIGNATION Is a Mental Health professional comparable to a PCP or a Specialist? Issue of co-pay. Unintended Consequences –Utilization –Operations Issues

6. CLINICAL MANAGEMENT STRATEGIES Opportunity exists to medically manage benefit. Must disclose Medical Necessity Criteria to members and providers. Manage outpatient services efficiently – outlier review. Manage all facility-based services. Manage state mandates closely. Case Management and Disease Management programs. Health Service Codes review. Tier Professional Network.

7. OPERATIONAL IMPLEMENTATION Business Units Legal Behavioral health Project Management IT Product Management Compliance Account Management Operations Marketing – Communications Actuarial Underwriting

8. COST OF CARE IMPLICATIONS Behavioral Health cost of care typically = 3% to 4% total of medical Projected average BH cost of care increase related to Parity*: Relative BH cost of care increase based on benefit starting position*: *Milliman Cost of Care Guidelines In summary... COC Impact Depends!