Jan 29, 2010
Three Departments, Health and Human Services, Labor, and the Treasury, jointly issued new rules for consumers enrolled in group health plans who need treatment for mental health or substance use disorders.
"The rules we are issuing today will, for the first time, help assure that those diagnosed with these debilitating and sometimes life-threatening disorders will not suffer needless or arbitrary limits on their care," said HHS Secretary Sebelius. "I applaud the long-standing and bipartisan effort that made these important new protections possible."
The new rules prohibit group health insurance plans (typically offered by employers) from restricting access to care by limiting benefits and requiring higher costs to patients than those that apply to general medical or surgical benefits. The new rules will carry out the Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
The new law requires that any group health plan that includes mental health and substance use disorder benefits along with standard medical and surgical coverage must treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review. 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 use disorders and medical or surgical benefits. The benefits must be calculated as one limit. The MHPAEA applies to employers with fifty or more workers whose group health plan chooses to offer mental health or substance disorder benefits. The new rules are effective for group health plan years beginning on or after July 1, 2010. Comments on the rules issued today are still being sought at the federal rule making portal https://www.regulations.gov/ .
