Regulators Issue Final Mental Health Parity Rule

The Departments of Labor, Health and Human Services 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. The rule ensures health plan features like copays, deductibles and visits limits are generally not more restrictive for mental health/substance abuse disorder benefits than they are for medical/surgical benefits.

The rule 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 an exception to the existing parity rule that was determined to be confusing, unnecessary and open to abuse.

The Patient Protection and 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.

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 (see “Treasury, HHS Issue New Rules on Mental Health Parity”).

The final rules may be viewed at https://www.federalregister.gov.

A fact sheet on the rules is available here.