Mental Health Parity Set to Go Nationwide July 1

Article excerpt

Large group health plans must treat mental health and substance abuse services the same way they treat medical and surgical services under new government regulations that will take effect July 1.

The rules implementing the Mental Health Parity and Addiction Equity Act of 2008 will ensure that plans not impose a different, more stringent set of restrictions on mental health and substance abuse treatment.

About 150 million Americans receive health insurance coverage through large group health plans, defined in the regulations as those sponsored by employers with 50 or more workers. About 90% of these plans include mental health coverage and therefore will be affected.

The rules, published Feb. 2 in the Federal Register, will prohibit large group health plans from restricting access to mental health and substance abuse care by limiting benefits and requiring higher patient cost-sharing when compared to general medical or surgical benefits.

The regulations do not require the plans to cover mental health services.

Administration officials speaking on background at a press briefing in late January said the rules would bar plans from imposing different financial requirements, such as copayments, deductibles, and treatment limits, on mental health and substance abuse benefits.

To pass the test imposed by the new rules, financial requirements for mental health and substance abuse services must not be more restrictive than those imposed on "substantially all" medical and surgical benefits.

For example, an administration official said, if a plan expects to pay $1 million for outpatient, in-network medical services and $750,000 of that total would be subject to a copayment, then that co-payment is considered to apply to "substantially all" medical and surgical benefits. Therefore, the copayment for mental health and substance abuse services could not be any higher, the administration official said.

Plans also will not be allowed to implement separate deductible and out-of-pocket limits for mental health/substance abuse and medical/surgical services. Instead, the categories must be combined into a single total deductible or out-of-pocket limit, the administration official said.

The rules also apply to medical management by group health plans. …

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