Final Parity Ruling Issued on Mental Health and Substance Use Disorders

Date: 

12/24/2013

On November 8, 2013, the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury passed a final ruling increasing parity of benefits for the treatment of mental health and substance use disorder services. HHS Secretary, Kathleen Sebelius, said,

“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.”

This final rule implements the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), and ensures that large group health plans feature the same co-pays and deductibles, and visit limits are generally not more restrictive for mental health/substance abuse disorders benefits than they are for medical/surgical benefits.

The MHPAEA breaks down financial barriers to guarantee that insurance plans offer more affordable, accessible mental health and substance abuse services. Specific consumer protections are also included to ensure parity and transparency for intermediate levels of care in residential or outpatient settings, and for all plan standards regardless of location, type of facility, and network adequacy. The Act prohibits insurance companies from limiting certain benefits based on “clinically appropriate standards of care,” which has been proven confusing and open to possible abuse. The MHPAEA also acts as a turning point for insurance companies that will increase treatment access, eliminate discriminatory practices, and ensure more affordable, effective care for Americans.

It should also be noted that The Affordable Care Act (ACA) builds on MHPAEA and requires coverage of mental health and substance use disorder services as one of 10 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 result of the final ruling on MHPAEA combined with ACA’s provisions break down financial barriers to behavioral health care and provide consumer protections that was previously unavailable.

MHPAEA resulted, in part, from the work of The President’s New Freedom Commission on Mental Health that was chaired by NIAC member Michael F. Hogan, Ph.D., former Director of the Ohio Department of Mental Health. The findings and recommendations of this Commission may be found in a 2003 final report - Achieving the Promise: Transforming Mental Health Care in America.

A copy of the press release may be found at http://www.hhs.gov/news/press/2013pres/11/20131108b.html

A comprehensive fact sheet on the rules can be found at http://cms.hhs.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/mhpaea_factsheet.html

Additional information on mental health parity may be found at: http://www.kaiserhealthnews.org/stories/2013/december/03/michelle-andrews-expert-answers-mental-health-parity.aspx?referrer=search and at http://www.bazelon.org/Where-We-Stand/Access-to-Services/Mental-Health-Parity.aspx.