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US government issues final rules under Mental Health Parity and Addiction Equity Act

from Employee Assistance Professionals Association

On Nov 8, the U.S. Departments of Health and Human Services, Labor and the Treasury jointly issued a final rule increasing parity between mental health/substance use disorder benefits and medical/surgical benefits in group and individual health plans. The final rule implements the Mental Health Parity and Addiction Equity Act (MHPAEA) and ensures that health plan features like co-pays, deductibles and visit limits are generally not more restrictive for mental health/substance abuse disorders benefits than they are for medical/surgical benefits. The final rules also include specific additional consumer protections, such as:

• 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 based on "clinically appropriate standards of care," which clinical experts advised was not necessary and which is confusing and open to potential abuse.

The Affordable Care Act builds on the 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 also are required to comply with these parity regulations.

For additional information on related issues, visit EAPA's Public Policy section here.


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