The Mental Health Parity and Addiction Equity Act (MHPAE) was signed into law by President George Bush in 2008.
The long awaited rules have just been issued by Health and Human Services. This law requires group health plans (both self- insured and fully insured plans with 50 or more employees) to ensure that financial requirements (such as co-pays and deductibles) and treatment limitations (such as caps on doctor visits) that apply to mental-health or substance-abuse benefits are no more restrictive than the limits that insurance plans place on medical or surgical benefits. For example, if you plan has a $30 deductible to see a health specialist (Cardiologist, OBGYN, etc), then your mental health professional will have that same deductible.
The act does not mandate that all plans provide mental-health and substance-abuse benefits, just that they provide parity with medical/surgical benefits if they do. However, under the ACA, “mental health and substance-use disorder services” are considered an “essential health benefit” that non-grandfathered insurance plans in the individual and small-group markets must cover beginning in 2014.
Among other issues, the final rules also:
- Incorporate clarifications contained in a series of FAQs that federal agencies issued since releasing the interim final rules.
- Provide new clarifications on issues such as the statute’s exemption for cost increases incurred by plans that make changes to comply with the law.
- Ensure that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings.
- Apply parity to all plan standards, including geographic limits, facility-type limits and network adequacy.
- Clarify that the definitions of “medical/surgical benefits,” “mental-health benefits,” and “substance-use-disorder benefits” include benefits for items as well as services, and that health plans define medical conditions/surgical procedures, and mental-health conditions/substance-use disorders according to applicable state and federal laws, including the ACA’s essential health benefits coverage requirements.
Reference:
- Final Mental Health Parity Rules Issued, 11/11/2013, By Stephen Miller, CEBS
- HHS, Labor and Treasury Departments Release Final Mental Health Parity Rules, Faegre Baker Daniels LLP, November 2013.
