On November 9, 2013, in a move to ensure equal benefits for those suffering from mental illness, the US federal government issued a final rule on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
MHPAEA requires private health insurance plans to provide equal coverage for mental and physical health services. Congress passed MHPAEA so adults and children suffering from mental health disorders, such as anxiety and depression, and substance use disorders, such as those related to alcohol use, would have better access to the treatment they need.
The MHPAEA requires group health plans to ensure that financial requirements (such as co-pays 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.
Highlights of the final rules include that group health plans:
- Apply parity to intermediate levels of care (by requiring identification of intermediate services for mental health and substance abuse care, and then mandating comparable treatment);
- Apply parity to all group health plan standards, including geographic location, facility type, provider specialty, and other criteria that could limit the scope or duration of benefits;
- Eliminate an exception from the parity rules for mental health and substance abuse treatment based on “clinically appropriate standards of care;” and
- Clarify the disclosure rights of participants with respect to mental health and substance abuse benefits.
The final rules apply to group health plan years beginning on or after July 1, 2014, for employers with 50 or more employees. Employers should plan accordingly for timely compliance and discuss these upcoming changes with their benefit broker. Certain exceptions apply for small group health plans, plans grandfathered under the Affordable Care Act (ACA), self-insured state and local government plans, retiree-only plans, and plans qualifying for the increased cost exemption under the MHPAEA.
Building on the MHPAEA, the ACA requires insurers to guarantee that financial requirements like co-pays and deductibles, as well as limits on doctors’ visits and care management, are no more restrictive in the behavioral health field than requirements or limitations on other medical or surgical benefits.