Lamberton Law Blog

The Departments of Labor, Health and Human Services and the Treasury recently issued a final rule increasing parity between mental health/substance use disorder benefits and medical/surgical benefits in group and individual health plans. The final rule implements the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, and ensures that health plan features like co-pays, deductibles and visits limits are generally not more restrictive f or mental health/substance abuse disorders benefits than they are for medical/surgical benefits. The final rule also includes specific additional consumer protections, such as:

1. Ensuring that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings;
2. Clarifying the scope of the transparency required by health plans, including the disclosure rights of plan participants, to ensure compliance with the law;
3. Clarifying that parity applies to all plan standards, including geographic limits, f acility-type limits and network adequacy; and
4. Eliminating an exception to the existing parity rule that was determined to be conf using, unnecessary and open to abuse.

The Affordable Care Act builds on the Mental Health Parity and Addiction Equity Act and requires coverage of mental health and substance use disorder services as one of ten essential health benefits categories. Under the essential health benefits rule, individual and small group health plans are required to comply with these parity regulations. The final rule represents a strong effort to expand coverage to the millions of Americans who have lacked access to affordable treatment f or mental and substance use disorders. It will increase access to mental health and substance abuse treatment, prohibit discriminatory practices and increase health plan transparency. “This final rule breaks down barriers that stand in the way of treatment and recovery services f or 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 af f ordable and accessible.” “Americans deserve access to coverage f or 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.”