Administration Issues Mental Health Parity Rule

WASHINGTON — Under a proposed rule released by the Obama administration, patients in a group insurance plan who are being treated for mental illness or substance abuse may no longer be charged more than if they were receiving medical or surgical care.

The Department of Health and Human Service (HHS), the Department of Labor, and the Internal Revenue Service issued an interim rule last week containing specific language necessary to enforce the bipartisan mental health parity law passed by Congress in 2008.

The law — called the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act — states that if a group health plan covers the treatment of mental illness or drug or alcohol abuse, the limits and financial requirements for these services can be “no more restrictive” than those that apply to medical and surgical benefits.

That means an insurance plan cannot charge higher copayments, deductibles, and out-of-pocket expenses for mental health services than for treatment of physical illnesses.

Companies with fewer than 50 employees in their group insurance plans are excluded from the law.

“The rules we are issuing today will, for the first time, help assure that those diagnosed with these debilitating and sometimes life-threatening disorders will not suffer needless or arbitrary limits on their care,” said Kathleen Sebelius, secretary of HHS.

The American Psychological Association (A), a longtime proponent of mental health parity, said it was pleased with the proposed rule.

“We are delighted that under these regulations consumers are protected from insurance discrimination to the greatest extent possible,” said A Executive Director for Professional Practice, Katherine Nordal, MD, in a prepared statement.

The rule also requires a single deductible for mental health and medical/surgical coverage. Patients who are being treated for a mental condition at the same time as somatic condition often have to pay separate deductibles which can “prevent access to mental health treatment,” according to the A.

“It is particularly significant that the regulation will ban health plans from imposing separate deductibles or setting separate out-of-pocket caps for mental health and medical/surgical services,” Nordal said. “This is a big win for anyone seeking mental health treatment.”

The 2008 law expanded greatly on the Mental Health Parity Act of 1996, which required parity only in lifetime and annual dollar limits. In practice, crtics say, insurers got around that prohibition by charging higher copayments for mental health services and by “cherry-picking” services that would and would not be covered.

The 1996 law also specifically excluded coverage parity for substance abuse treatment.

The A said the proposed rule still fails to address several technical insurance issues regarding provider networks and formularies, and the group will state its case during the 90-day comment period, which is open now.

The rule will take effect April 5, 2010.

source : www.medpagetoday.com

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