The Obama administration issued a final rule increasing parity between mental health and substance use disorder benefits and medical and surgical benefits in health plans.
The final rule, issued by the departments of Health and Human Services, Labor and Treasury, implements the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. It is designed to ensure that health plan features such as co-pays, deductibles and visit limits generally are not more restrictive for mental health and substance abuse disorders benefits than they are for medical and surgical benefits, according to an HHS news release.
Under MHPAEA, plans must adhere to the new rule if they cover private employers with more than 50 employees or non-federal governmental employers with more than 100 employees. The Affordable Care Act ensures the same rules apply to those in individual and small-group plans. The rule does not apply to Medicaid and Children’s Health Insurance Program managed care plans.
Nonetheless, the rule provides a crucial step forward to ensure that patients receive the benefits they deserve and are entitled to under the law, Jeffrey Lieberman, MD, president of the American Psychiatric Association, said in a statement.
The action includes additional consumer protections, such as:
Ensuring that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings;
Clarifying the scope of the transparency required by health plans, including the disclosure rights of plan participants, to ensure compliance with the law;
Clarifying that parity applies to all plan standards, including geographic limits, facility-type limits and network adequacy;
Eliminating the provision that allowed insurance companies to make an exception to parity requirements for certain benefits based on clinically appropriate standards of care, which clinical experts advised was not necessary and which is confusing and open to potential abuse.
By issuing this rule, the administration has completed or made significant progress on all 23 executive actions included in a plan by President Obama and Vice President Joe Biden to reduce gun violence, according to a news release. The effort began after the December 2012 shooting deaths of 20 children and six adults at an elementary school in Newtown, Conn.
In January, as part of the plan to reduce gun violence, the Obama administration committed to finalize this rule as part of a larger effort to increase access to affordable mental health services and reduce the misinformation associated with mental illness. Mental illness should no longer be treated by our society or covered by insurance companies differently from other illnesses, Obama and Biden stated.
This final rule breaks down barriers that stand in the way of treatment and recovery services for millions of Americans, HHS Secretary Kathleen Sebelius said in the news release. Building on these rules, the Affordable Care Act is expanding mental health and substance use disorder benefits and parity protections to 62 million Americans. This historic expansion will help make treatment more affordable and accessible.
The final Mental Health Parity and Addiction Equity Act rule was developed based on the departments review of more than 5,400 public comments on the interim final rules issued in 2010.
Fact sheet: http://cms.hhs.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/mhpaea_factsheet.html
Report on executive actions related to reducing gun violence: www.whitehouse.gov/sites/default/files/docs/november_exec_actions_progress_report_final.pdf