Journalist explains what to expect from new mental health parity rules

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at joseph@healthjournalism.org.

Michelle Andrews

Michelle Andrews

Later this year, health plans will be under new mental health parity rules affecting how insurers should cover patients with mental health and substance abuse disorders.

Michelle Andrews, a health policy reporter and columnist for Kaiser Health News, explains the issue in a new tip sheet,  “Mental health parity rule clarifies standards for treatment limits, coverage of intermediate care.”

These rules, governing the limits that health insurers can place on coverage for patients needing mental health and substance abuse care, will be important to consumers for several reasons. One reason involves what services health plans must provide when covering mental health benefits –keep in mind that health plans do not need to offer mental health care. But if they do, they need to cover inpatient and outpatient services, emergency room care and prescription drugs, Andrews reports. Also, the rules prohibit health insurers from setting limits on treatment that are more restrictive than the limits set on a plan’s medical-surgical coverage, she adds.

In addition, intermediate-level mental health services, such as residential treatment and intensive outpatient services for patients needing substance abuse treatment or mental health care, should be covered at the same level as the insurer covers residential and intensive outpatient services for medical-surgical patients, Andrews adds. Often patients needing mental health and substance abuse care require residential or intensive outpatient treatment.

The new parity rules also do not allow health insurers to charge higher co-payments, deductibles, or out-of-pocket maximums for mental health and substance abuse treatment without setting similar co-payment, deductibles, and out-of-pocket limits for medical-surgical coverage.

Officially, the rules were issued on Nov. 8 when the secretaries of the departments of Labor, Health and Human Services, and Treasury issued the final regulations for health insurers implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. They will be effective for health plan years that begin after July 1, 2014, which for most plans, means Jan. 1, 2015.

Also included with the tip sheet is a list of organizations offering more information on the parity law and the regulations.

In the coalition’s summary and analysis is a brief explanation (reiterated by Andrews) that the regulations do not apply to Medicaid managed care plans, the Children’s Health Insurance Program (CHIP), or the Medicaid expansion plans some states are implementing under the Affordable Care Act (called alternative benefit plans). Regulations for these entities are forthcoming, the coalition said.

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