The Departments of Health and Human Services, Labor and the Treasury jointly issued a final rule on parity between mental health/substance use disorder benefits and medical/surgical benefits in group and individual health plans. Released on November 8, 2013, the final rule implements the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (2008), that generally prohibits insurance companies from making co-payments, deductibles, and visit limits more restrictive for mental health/substance abuse disorders benefits than for medical/surgical benefits. Consumer protections contained in the final rule include:
- 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; and
- Ensuring parity for residential and outpatient services. While the final rule does not require that residential treatment services for mental health/substance abuse/addiction disorders be covered, it does require that health insurers offering “post-acute care services” also cover residential treatment and other intermediate services for behavioral health issues. I.e., if a health insurance plan covers chemotherapy (a post-acute oncology intervention after hospitalization), then it must cover residential treatment of a substance use disorder or eating disorders. Further, if an insurer does not require a patient to go out-of-state to access post-acute medical/surgical care, then it cannot require patients with mental illnesses or addiction disorders to access out-of-state behavioral health residential treatment services.
Interim final rules on mental health parity were issued in 2010, and this final rule was developed and finalized following federal review of more than 5,400 public comments.
The rule has an effective date of July 2, 2014.