Insurers Must Offer Equal Coverage for Those With Emotional, Addiction Problems
FRIDAY, Jan. 29 -- Group health insurance plans can no longer limit benefits and require higher patient costs for people with mental health or substance abuse disorders, according to new rules issued Friday by the U.S. government.
Any group health plan -- typically offered by employers -- that includes mental health and substance abuse disorder benefits must treat them equally with standard medical and surgical coverage in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review, according to the new rules.
"These practices must be based on the same level of scientific evidence used by the insurer for medical and surgical benefits. For example, a plan may not apply separate deductibles for treatment related to mental health or substance abuse disorders and medical and surgical benefits -- they must be calculated as one limit," said a news release from the U.S. Health and Human Services Department.
The new rules, effective for plan years beginning on or after July 1, 2010, implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which expands on the earlier Mental Health Parity Act of 1996. The new act is named for two federal lawmakers who pushed for equal treatment of mental health and substance abuse disorder benefits.
MHPAEA applies to businesses with 50 or more employees whose group health plan offers mental health and substance abuse disorder benefits.
The Departments of Health and Human Services, Labor and the Treasury jointly issued the new parity rules, which were developed based on the departments' review of more than 400 public comments on the issue.
"Workers covered by group health plans who need mental health and substance abuse care deserve fair treatment. These rules expand on existing protection to ensure that people don't face unnecessary barriers to the treatment they need," Deputy Treasury Secretary Neil Wolin said in the news release.
"Today's rules will bring needed relief to families faced with meeting the cost of obtaining mental health and substance abuse services," added Secretary of Labor Hilda L. Solis. "The benefits will give these Americans access to greatly needed medical treatment, which will better allow them to participate fully in society."
Mental Health America explains how to find mental health care.
Posted: January 2010