Mental Health Parity Act

Summary#

Bill C-280 would enact a new law and amend the Federal-Provincial Fiscal Arrangements Act. The supplied bill title says it would enact the Mental Health, Addictions and Substance Use Services Act, but the bill text gives the new law the short title Mental Health Parity Act. Its stated goal is to encourage provinces to develop these services by helping meet their costs.

• To receive the full Canada Health Transfer cash contribution, a province would have to meet new rules for insured mental health, addictions and substance use services. These include public administration, comprehensive coverage, universality, portability and accessibility.
• Provincial plans would have to cover all services within the bill’s definition, including medically required services in community settings. Regulations could add specific services and access standards.
• Plans could not permit extra-billing for insured services or user charges, with an exception for certain accommodation or meals for long-term hospital patients. Deductions could be made from a province’s contribution for extra-billing or user charges.
• The Governor in Council could reduce or withhold a province’s contribution for other failures to meet the rules, after the bill’s notice and consultation steps. It could withhold the whole contribution if it considers that appropriate.
• The federal Health Minister would have to report annually to Parliament. The Governor in Council could make regulations after consulting provincial health ministers.

What it means for you#

• People using services: The bill would set conditions on provincial plans receiving the full federal contribution; it does not itself guarantee that a particular person will receive a service. “Insured person” excludes, among others, members of the Canadian Forces and people serving a term in a penitentiary.
• Provinces: To qualify for the full contribution, provincial plans would have to insure the services covered by the bill and meet its other conditions. They would also have to provide information, recognize the Canada Health Transfer in related public material, and meet public reporting requirements set by regulation.
• Health care practitioners and hospitals: The bill requires plans to provide for payment for insured services under a provincial tariff or payment system, reasonable compensation for medical practitioners, and payments to hospitals for service costs.
• Federal government: The Health Minister would assess compliance and could refer defaults to the Governor in Council. The bill does not create a new federal service provider.
• Current law: The parent Act is not supplied, so I could not verify how these amendments would change its current provisions or how they would interact with existing provincial coverage.

Money#

No publicly available information gives an estimate of the bill’s public cost.

• Provinces would have to insure the services covered by the bill to qualify for the full contribution. The bill gives no estimate of provincial costs or the amount of any new federal contribution.
• The bill authorizes reductions or withholding of federal contributions and requires deductions tied to extra-billing or user charges. It does not estimate those amounts.
• The bill requires federal reporting and provincial information-sharing, but gives no staffing or administrative cost estimates.

What is unclear#

• The bill does not say when it would come into force. Its passage or current status is not stated in the supplied material.
• “Medically required” and “reasonable access” are not defined in the bill. Regulations could specify covered services and access standards, but their content is not provided.
• The bill does not set out how provinces would assess individual coverage claims, resolve disputes, or appeal decisions.
• The bill does not explain how the new conditions would interact with existing provincial programs or coverage.
• The discrepancy between the supplied bill title and the short title in the bill text leaves the intended name of the new Act unclear.

Case for#

• The bill appears intended to address financial and other barriers to mental health, addictions and substance use care, including community-based services that the preamble says are not required to be insured under the Canada Health Act.
• A possible argument for the bill is that common coverage and access conditions could encourage provinces to insure a broader range of services.
• Linking those conditions to federal contributions could give provinces financial support while setting national requirements.

Case against#

• One concern is that the bill uses federal funding to press provinces to meet broad requirements, while allowing the Governor in Council to reduce or withhold contributions.
• The bill does not define key standards such as “medically required” or “reasonable access.” Regulations would determine important parts of what provinces must cover.
• The bill does not estimate the cost of the required coverage or explain how provinces would pay for it.
• It is unclear how the new rules would fit with current provincial coverage and other programs.