New Rules Mandate Mental Health Coverage

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Today, as part of the Obama administration's continuing efforts to increase access to mental health services, the final rule implementing the Mental Health Parity and Addiction Equity Act of 2008 was issued.

Health and Human Services Secretary Kathleen Sebelius announced Friday that new regulations will require health insurers to treat mental health coverage like all other aspects of healthcare, the culmination of a long effort to achieve parity for mental health coverage and part of Obama’s effort to curb gun violence. The regulations put into effect a 2008 law, and will affect nearly 85 percent of Americans with health insurance. Insurers will be required to pay as much for mental health as they do for medical and surgical procedures, and cannot limit the geographical area where mental health care is covered.

The final rule issued today implements the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, and ensures that health plans features like co-pays, deductibles and visit limits are generally not more restrictive for mental health/substance abuse disorders benefits than they are for medical/surgical benefits.

Today’s action also includes specific additional consumer protections, such as:

- 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; and

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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.

“This final rule breaks down barriers that stand in the way of treatment and recovery services for millions of Americans,” said Health and Human Services Secretary Kathleen Sebelius. “Building on these rules, the Affordable Care Act is expanding mental health and substance use disorder benefits and parity protections to 62 million Americans. This historic expansion will help make treatment more affordable and accessible.”

“Americans deserve access to coverage for mental health and substance use disorders that is on par with medical and surgical care,” said Treasury Secretary Jacob J. Lew. “These rules mark an important step in ending the disparities that exist in insurance plans, and will provide families nationwide with critical coverage and protections that fulfill their health needs.”

“New efforts are underway to expand coverage to the millions of Americans who have lacked access to affordable treatment for mental and substance use disorders,” said Labor Secretary Thomas E. Perez. “These rules will increase access to mental health and substance abuse treatment, prohibit discriminatory practices, and increase health plan transparency. Ultimately, they’ll provide greater opportunities for affordable, accessible, effective treatment to Americans who need it.”

In issuing the regulations, the administration will have acted on all 23 executive actions that the president and Vice President Joseph R. Biden Jr. announced early this year to reduce gun crimes after the Newtown, Connecticut school massacre.

An updated report summarizing the status of all 23 executive actions is available here. The final rules can be viewed here, and a fact sheet on the rules is available here.

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