New Rule Increases Parity for Mental Health, Substance Abuse Disorder Coverage

The Departments of Health and Human Services, Labor and the Treasury today issued a final rule increasing parity between mental health/substance use disorder benefits and medical/surgical benefits in group and individual health plans.

RELATED: Healthcare Policies

Today’s final rule ensures that health plan features like copays, deductibles, and visit lmits are generally not more restrictive for mental health/substance abuse disorders benefits than for medical/surgical benefits.

The additional consumer protections include:

  • 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

The Affordable Care Act builds on the Mental Health Parity and Addiction Equity Act and requires coverage of mental health and substance abuse services as one of ten essential health benefits categories.  

The final Mental Health Parity and Addiction Equity Act rule was based on the departments’ review of more than 5,400 public comments on the interim rules issued in 2010.

For more information call (877) 696-6775 or read more on the final rules here