The Departments of Health and Human Services (HHS), Labor and the Treasury have jointly issued new rules providing parity for consumers enrolled in group health insurance plans, for the treatment of mental health or substance use disorders. The new rules are effective for plan years beginning on or after July 1, 2010.

"The rules ... will, for the first time, help assure that those diagnosed with these debilitating and sometimes life-threatening disorders will not suffer needless or arbitrary limits on their care," said HHS Secretary Kathleen Sebelius. "I applaud the long-standing and bipartisan effort that made these important new protections possible."

"[The] rules will bring needed relief to families faced with meeting the cost of obtaining mental health and substance abuse services," said U.S. Secretary of Labor Hilda L. Solis. "The benefits will give these Americans access to greatly needed medical treatment, which will better allow them to participate fully in society. That's not just sound policy, it's the right thing to do."
"Workers covered by group health plans who need mental health and substance abuse care deserve fair treatment," said Deputy Treasury Secretary Neal Wolin. "These rules expand on existing protections to ensure that people don't face unnecessary barriers to the treatment they need."

These rules will implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The late Paul Wellstone was a long time advocate on mental health issues. The law expands upon the Mental Health Parity Act of 1996, which did not include substance abuse disorder provisions. According to the text of the law, such mental health or substance use disorder (MH/SUD) benefits in a plan may be no more restrictive than the predominant financial requirements applied to substantially all medical and surgical benefits covered by the plan, and there are no separate cost sharing requirements that are applicable only with respect to MH/SUD benefits. Treatment limitation includes limits on the frequency of treatment, number of visits, days of coverage, or other similar limits on the scope or duration of treatment.

MH/SUD benefits may not be subject to any separate cost sharing requirements or treatment limitations that only apply to such benefits; if a group health plan includes medical/surgical benefits and MH and or SUD benefits, and the plan provides for out-of-network medical/surgical benefits, it must provide for out- of-network MH and/or SUD benefits; standards for medical necessity determinations and reasons for denial of benefits relating to MH/SUD must be disclosed upon request. Small employers who have between two and 50 employees are exempt from MHPAEA requirements. In addition, large group health plan sponsors that can demonstrate that compliance with MHPAEA increases their claims by at least two percent in the first year may request exemption from the MHPAEA.

Comments on the interim final rules are still being solicited by the agencies involved, including on "non-quantitative" treatment limits, the formularies on covered drugs, coverage of step-therapies and on "scope of benefits" or continuum of care.

Comments on the interim final regulation are due 90 days after the publication date. The comments should be sent to any of the three agencies, who will share them with each other, duplicate comments should not be submitted. Comments may be emailed to the federal rule-making portal at: http://www.regulations.gov. The codes to include in agency comments are CMS-4140-IFC for HHS; RIN 1210-AB30 for the Department of Labor; and REG-120692-09 for the Department of the Treasury.

Adapted in part from an HHS news release.
http://www.hhs.gov/news/press/2010pres/01/20100129a.html

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