Federal government expands mental health parity coverage

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Group health plans will be required to provide coverage for mental and substance use disorders that is equivalent to their medical benefits under a new rule issued by the Obama administration.

The rule, which was jointly issued by the Departments of Health and Human Services, Labor and the Treasury last week, prohibits group health insurance plans from restricting access to care by limiting benefits and requiring higher patient contributions, according to an HHS press release. The rules implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

MHPAEA expands on an earlier law, the Mental Health Parity Act of 1996, which required parity only in aggregate lifetime and annual dollar limits between the categories of benefits and did not extend to substance use disorder benefits. The new law, which applies to employers of 50 or more workers, requires that any group 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.

The mental health and substance use coverage 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.

The new rules will come into effect for plan years beginning on or after July 1, 2010. Comments on the interim final rules are being solicited for the next 90 days. Sections where further comments are being specifically sought include non-quantitative treatment limits, such as those that pertain to the scope and duration of covered benefits, drug formularies, and the coverage of step-therapies. Comments are also being specifically requested on the regulation's section on scope of benefits or continuum of care. Comments may be emailed through the federal rulemaking portal.