Mental Health and Substance Abuse Parity Law Implemented

 

As reported in the November 2009 MGH Community News (“Federal Mental Health Parity Law in Effect in January”), the Paul Wellstone, Pete Domenici Parity Act, passed in 2008, becomes effective in 2010. On January 29, 2010, the US Departments of Health and Human Services, Treasury and Labor released interim regulations providing guidance on how the Act must be implemented. The interim regulations go into effect on April 5, 2010 and apply to group insurance plans with plan years starting on July 1, 2010 or later.

The interim regulations apply to group insurance plans of 50 or more people. Although the Wellstone-Domenici law also applies to Medicaid managed care plans, these plans are not included in the interim regulations. The new rules prohibit group health insurance plans—typically offered by employers—from restricting access to care by limiting benefits and requiring higher patient costs than those that apply to general medical or surgical benefits. The new law requires that any group health plan that includes mental health and substance use disorder benefits along with standard medical and surgical coverage must treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review. These practices must be based on the same level of scientific evidence used by the insurer for medical and surgical benefits. For example, a plan may not apply separate deductibles for treatment related to mental health or substance use disorders and medical or surgical benefits—they must be calculated as one limit. The law applies to employers with 50 or more workers whose group health plan chooses to offer mental health or substance use disorder benefits.

For more detail see Federal Mental Health Parity Law in Effect in January, MGH Community News, November 2009.

-From: “Interim Regulations announced for the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008”, Faces and Voices of Recovery; Organizing the Recovery Movement, at http://www.facesandvoicesofrecovery.org/about/campaigns/equity.php, retrieved 2/23/10, and “Obama Administration Issues Rules Requiring Parity in Treatment of Mental, Substance Use Disorders”, News Release, January 29, 2010 at http://www.hhs.gov/news/press/2010pres/01/20100129a.html retrieved 2/23/10.

 

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