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Mental Health Parity Final Regulation Released
On November 8, 2013 the Departments of Labor, Health and Human Services (HHS) 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, set to take effect in January 2014.
The long-awaited Final Rules implement the Mental Health Parity and Addiction Equity Act of 2008 (MHP) which requires group health plans to ensure that financial requirements (such as copays 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. 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 Patient Protection and Affordable Care Act (ACA), mental health and substance-use disorder services are considered an essential health benefit that, beginning in 2014, insurance plans in the individual and small-group markets must cover.
Mental Health Parity is important to the HD community because it requires insurers to cover mental health benefits and medical/surgical benefits at the same level. This means that insurers must charge similar copays for physical and mental health visits. Moreover, insurers cannot charge higher deductibles or have different visit limits for mental health care. Given that the ACA mandates coverage for mental-health as one of their Essential Health Benefits, this means that plans sold in the Insurance Marketplaces will now have to cover mental health benefits, which are a vital part of living well with HD. HDSA weighed in on several occasions to ask that mental health benefits mandated by the Essential Health Benefits package meet the needs of individuals living with HD.
The final rules apply to group and individual insurance policies, but not to Medicaid or Medicare.
Click here to read the Final Rule, which affects insurance policies for policy years beginning on or after July 1, 2014.
Click here to read the HHS news release
Click here to read the FAQ from the Centers for Medicare and Medicaid Services, which were released with the Final Rule.
Click here for a fact sheet about MHP from the Centers for Medicare and Medicaid Services
Click here to read a more detailed summary of the final rule