Final Mental Health Parity Rule Issued

The U.S Departments of Health and Human Services, Labor, and the Treasury jointly issued the final rule on parity under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) in November. The regulation is effective January 13, 2014 and generally applies to plan years (in the individual market, policy years) beginning on or after July 1, 2014.
Originally passed in 2008, MHPAEA requires insurance plans that cover mental health or substance use disorders to provide the same level of benefits that they do for general medical treatment.
What’s Included in the Federal Parity Law?

The requirement applies to:

  • copays, coinsurance, and out-of-pocket maximums;
  • limitations on services utilization, such as limits on the number of inpatient days or outpatient visits that are covered;
  • the use of care management tools;
  • coverage for out-of-network providers; and
  • criteria for medical necessity determinations.

MHPAEA does not require insurance plans to offer coverage for mental illnesses or substance use disorders in general, or for any specific mental illness or substance use disorder. It also does not require plans to offer coverage for specific treatments or services for mental illness and substance use disorders. However, coverage that insurance plans do offer for mental and substance use disorders must be provided at parity with coverage for medical/surgical health conditions.

Read more about the Final Parity Rule at SAMHSA.gov.

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