Employer-provided group health plans now must offer the same level of coverage for treatments related to mental health or substance abuse disorders as for other medical or surgical procedures, according to a federal regulation issued Friday by the Department of Health and Human Services (HHS).
The new interim final rule implementing the Wellstone-Domenici Mental Health Parity and Addiction Equity Act of 2008 was developed following HHS' review of more than 400 public comments on how these mental health parity measures should be written.
"The rules we are issuing today 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 in a statement.
The interim final rule expands an earlier law, the Mental Health Parity Act of 1996, which required parity only in aggregate lifetime and annual dollar limits. It did not extend to substance use disorder benefits.
The measure also requires that group health plans' mental health and group medical and surgical benefits be treated equally in terms of out of pocket costs, benefit limits, and practices, such as prior authorization and utilization review. The practices must be based on the same level of scientific evidence used by an insurer for medical and surgical benefits.
The rule applies to employers with 50 or more employees whose group health plan chooses to offer mental health or substance use disorder benefits. The new rules are effective for plan years beginning on or after July 1, 2010.
Comments on the interim final rules are still being solicited—specifically in the areas of "non quantitative" treatment limits that pertain to the scope and duration of covered benefits and how formularies are determined. Comments are due 90 days after the publication date.
The Wellstone Domenici Act is named the late Sen. Paul Wellstone (D MN), who was a strong advocate for parity throughout his Senate career, and former Sen. Pete Domenici (R NM), who first introduced legislation to require parity in 1992. The issue of parity dates back more than 40 years to President John F. Kennedy, and was also supported by President Clinton and the late Sen. Edward Kennedy.
Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.