Advocacy E-News November 8, 2013

November 8, 2013

 

GOVERNMENT RELEASES FINAL RULE ON MENTAL HEALTH PARITY

New rule requires equal treatment for mental illness

Five years after the passage of a groundbreaking law establishing equality between mental health care and other medical treatments, the Obama administration will announce its final rule Friday defining how that treatment must be provided. White House officials said the rule would require insurers to charge similar co-payments for mental health treatment as they would for physical ailments, to not require insurer’s approval before prescribing a type of treatment and to clarify how parity will apply to inpatient and outpatient treatment for a variety of conditions.

For example, the rule ensures that parity applies to services such as residential or intensive outpatient treatment. It also clarifies the transparency requirements insurance companies must follow, so consumers can be equipped with the information they need to make sure their plans are complying with the law.

The final rule issued today implements the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act and ensures that health plan features such as copays, deductibles, and visit limits are generally not more restrictive for mental health/substance use disorders benefits than they are for medical/surgical benefits.

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

• 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 on the basis of “clinically appropriate standards of care,” which clinical experts advised was not necessary and which is confusing and open to potential abuse.

Go to the Mental Health Parity and Addiction Equity Act:
http://cms.hhs.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/mhpaea_factsheet.html