Doctor concerned with health care law

Breaking news and expert analysis on legal and compliance issues

[Back To Home][Back To Archives]

From Health Law Daily, November 8, 2013

Final regulations issued for mental health and addiction parity

By Kathryn S. Beard, JD

HHS, jointly with the Departments of Labor and Treasury, issued a final rule implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) (P.L. 110-343, secs. 511-12). The final rule, which will be published on November 13, ensures that health plans 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 mental health parity provisions of the final regulation apply to group health plans for plan years (or, in the individual market, policy years) beginning on or after July 1, 2014.

Parity. MHPAEA was passed in 2008, and is generally effective for plan years beginning after October 3, 2009. MHPAEA requires large employer-based health insurance plans to cover treatment for psychiatric illnesses and substance-abuse disorders in the same way that they cover treatment for diseases like cancer. MHPAEA prevents large group health plans from imposing annual or lifetime dollar limits on mental health or substance use disorder benefits that are less favorable than any such limits imposed on medical/surgical benefits. The Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) builds on MHPAEA, requiring coverage of mental health and substance use disorder services as one of ten essential health benefits categories. Under the essential health benefits rule, individual and small group health plans are required to comply with these parity regulations.

Final rule. This is the first final regulation issued under MHPAEA. An interim final rule was published in 2010, but the 5,400 comments received during the notice-and-comment period for the final rule were never addressed until now. The final rule includes consideration of and responses to the comments submitted by the public. The rule applies parity to intermediate levels of care received in residential treatment or intensive outpatient settings and eliminates a provision allowing insurance companies to make an exception for certain benefits based on “clinically appropriate standards of care.” It also clarifies that parity applies to all plan standards, including geographic limits, facility-type limits, and network adequacy, as well as clarifying the scope of transparency required by health plans, including plan participants’ disclosure rights.

MainStory: TopStory HealthCareReformNews AgencyNews HealthReformNews CoverageNews CopayNews

Health Law Daily

Introducing Wolters Kluwer Health Law Daily — a daily reporting service created by attorneys, for attorneys — providing same-day coverage of breaking news, court decisions, legislation, and regulatory activity.

A complete daily report of the news that affects your world

  • View full summaries of federal and state court decisions.
  • Access full text of legislative and regulatory developments.
  • Customize your daily email by topic and/or jurisdiction.
  • Search archives for stories of interest.

Not just news — the right news

  • Get expert analysis written by subject matter specialists—created by attorneys for attorneys.
  • Track law firms and organizations in the headlines with our new “Who’s in the News” feature.
  • Promote your firm with our new reprint policy.

24/7 access for a 24/7 world

  • Forward information with special copyright permissions, encouraging collaboration between counsel and colleagues.
  • Save time with mobile apps for your BlackBerry, iPhone, iPad, Android, or Kindle.
  • Access all links from any mobile device without being prompted for user name and password.