The Department of Health and Human Services, the Department of Labor, and the Treasury Department have jointly issued new rules providing parity for employees enrolled in group health plans who need treatment for mental health or substance use disorders.
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Download NowThe rules implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). 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.
MHPAEA applies to employers with 51 or more workers 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.
MHPAEA greatly expands on an earlier law, the Mental Health Parity Act of 1996 which required parity only in aggregate lifetime and annual dollar limits between the categories of benefits and did not extend to substance use disorder benefits. The new law expands parity to include deductibles, co-payments, out-of-pocket expenses, co-insurance, covered hospital stays, and covered out-patient visits.