New Rule Requires Equal Treatment For Mental Illness
By Kelly Kennedy and Aamer Madhani, USA TODAY November 8, 2013
Friday's announcement said insurers must charge similar co-payments and deductibles for mental and physical treatments.
- Rule follows passage of a 2008 law requiring parity
- Insurers may no longer limit certain types of mental health treatment
WASHINGTON — Five years after the passage of a groundbreaking law establishing equality between mental health care and other medical treatments, the Obama administration announced its final rule Friday defining how that treatment must be provided.
The rule requires insurers to charge similar co-payments for mental health treatment as they would for physical ailments. It also makes clear that deductible and visit limits are generally not more restrictive for mental health and substance abuse care.
"This final rule breaks down barriers that stand in the way of treatment and recovery services for millions of Americans," said Health and Human Services Secretary Kathleen Sebelius. "Building on these rules, the Affordable Care Act is expanding mental health and substance use disorder benefits and parity protections to 62 million Americans. This historic expansion will help make treatment more affordable and accessible."
HHS says the rule also includes several other consumer protections, including ensuring that parity is applied to care received in residential treatment and intensive outpatient settings, and clarifying that parity applies to all health care plan standards, including geographic limits and facility-type limits.
About 26% of Americans 18 and older have a diagnosable mental disorder every year, according to the National Institute of Mental Health.
"The rule will really dictate how parity gets implemented," said former representative Patrick Kennedy, who worked with his father, late senator Edward Kennedy of Massachusetts, on the Mental Health Parity Act. "We need to, most importantly, have the attitudes in the right places that this is something that's really going to revolutionize care."
In 2008, Congress passed and President George W. Bush signed into law the Mental Health Parity and Addiction Act, which demands that mental illnesses be treated the same as other illnesses. The argument: Those who have cancer are not denied care after 10 visits if they are not healthy; those with depression should also not be denied care if they are not healthy.
The announcement came as Sebelius attended a mental health conference at the Carter Center in Atlanta. Former first lady Rosalynn Carter has long been a proponent of mental health parity and was heavily involved in lobbying for the law.
The rule change announcement was made jointly by HHS and the Treasury Department.
"Americans deserve access to coverage for mental health and substance use disorders that is on par with medical and surgical care," said Treasury Secretary Jack Lew. "These rules mark an important step in ending the disparities that exist in insurance plans and will provide families nationwide with critical coverage and protections that fulfill their health needs."
Insurers, including the insurance industry trade group America's Health Insurance Plans, have argued that it's too difficult to compare physical illnesses to psychological illnesses in an apples-to-apples way, and they have insisted upon evidence-based guidelines. Mental health experts say they can do that.
The industry also has said the rules could cause premiums to go up. USA TODAY reported Wednesday that there may be an influx of young people diagnosed with mental health issues as they finally gain access to treatment.
However, Kennedy and other mental health experts said, catching those illnesses early may lead to lower costs in the long-term.
Kennedy, who suffers from mental illness, said he expects that the law will help employers save money, because workers will be more productive, and that young people dealing with depression or substance-abuse disorders may get the help they need to allow them to make them productive early-life career decisions.
Also, Kennedy said, improved mental health care will allow mentally ill people with other chronic issues to take better care of themselves.
"I don't think my liberal mind and bleeding heart will be the reason that this gets implemented," Kennedy told USA TODAY. "I believe it will be economics."
But he said everyone in the health system will need to change behaviors to make parity work. Primary-care physicians must ask questions to gain knowledge about a person's mental health, and then they must understand how to get that person further help. Mental health providers may need to start taking insurance to ensure people have access to care. And insurers will need to be transparent about mental health coverage.
"Doctors check cholesterol and blood pressure, but the notion that in this day and age, they ignore a check-up from the neck up that could make all the difference in all the rest of our health is hard to believe," Kennedy said. "We're still stuck in a time warp."
Administration Issues Final Mental Health And Substance Use Disorder Parity Rule
Final rules break down financial barriers and provide consumer protections
The Departments of Health and Human Services, Labor and the Treasury today 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 issued today implements the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, and 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.
Today’s action also includes 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.
By issuing this rule, the administration has now completed or made significant progress on all 23 executive actions included in the President and Vice President’s plan to reduce gun violence. An updated report summarizing the status of all 23 executive actions is available here:
In January, as part of the President and Vice President’s plan to reduce gun violence, the Administration committed to finalize this rule as part of a larger effort to increase access to affordable mental health services and reduce the misinformation associated with mental illness. As the President and Vice President have made clear, mental illness should no longer be treated by our society – or covered by insurance companies – differently from other illnesses.
The Affordable Care Act builds on the Mental Health Parity and Addiction Equity Act and requires 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.
“This final rule breaks down barriers that stand in the way of treatment and recovery services for millions of Americans,” said Health and Human Services Secretary Kathleen Sebelius. “Building on these rules, the Affordable Care Act is expanding mental health and substance use disorder benefits and parity protections to 62 million Americans. This historic expansion will help make treatment more affordable and accessible.”
“Americans deserve access to coverage for mental health and substance use disorders that is on par with medical and surgical care,” said Treasury Secretary Jacob J. Lew. “These rules mark an important step in ending the disparities that exist in insurance plans, and will provide families nationwide with critical coverage and protections that fulfill their health needs.”
“New efforts are underway to expand coverage to the millions of Americans who have lacked access to affordable treatment for mental and substance use disorders,” said Labor Secretary Thomas E. Perez. “These rules will increase access to mental health and substance abuse treatment, prohibit discriminatory practices, and increase health plan transparency. Ultimately, they’ll provide greater opportunities for affordable, accessible, effective treatment to Americans who need it.”
The final Mental Health Parity and Addiction Equity Act rule was developed based on the departments' review of more than 5,400 public comments on the interim final rules issued in 2010.
The final rules may be viewed at https://www.federalregister.gov.
A fact sheet on the rules is available here: http://cms.hhs.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/mhpaea_factsheet.html.