iThe U.S. Departments of Health and Human Services, Labor and the Treasury today jointly issued a final rule designed to increase parity between mental health/substance use disorder benefits and medical/surgical benefits in group and individual health plans.
According to a press release, “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.” The Rule includes the following provisions:
-
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
-
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.
The Rule, which applies to large group health plans, is effective for plan years beginning on or after July 1, 2014. The Final Rule may be viewed here. A fact sheet on the Rule is available here.
