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The Departments of Health and Human Services, Labor and the Treasury jointly issued a final rule increasing parity between mental health/substance use disorder benefits and medical/surgical benefits in group and individual health plans.
The final rule implements the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, and ensures that health plans features like co-pays, deductibles and visit limits are generally not more restrictive for mental health/substance abuse disorders benefits than they are for medical/surgical benefits.
Today’s action also includes specific additional consumer protections, such as:
- Ensuring that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings;
- Clarifying the scope of the transparency required by health plans, including the disclosure rights of plan participants, to ensure compliance with the law;
- Clarifying that parity applies to all plan standards, including geographic limits, facility-type limits and network adequacy; and
- Eliminating the provision that allowed insurance companies to make an exception to parity requirements for certain benefits based on “clinically appropriate standards of care,” which clinical experts advised was not necessary and which is confusing and open to potential abuse.
Gil Kerlikowske, director of the Office of National Drug Control Policy, said the rules will make a real difference for millions by ending discrimination against those who suffer from substance use and mental health disorders.
This will improve the ability of healthcare providers to identify the symptoms and treat problematic drug use before it becomes a chronic condition, Kerlikowske said.
The 2012 National Survey on Drug Use and Health found about 23 million Americans were in need of treatment for a substance use disorder, yet only 2.5 million — about 1-in-10 — actually received the treatment they need. The new rule makes it easier for those Americans to get the care they need by prohibiting certain discriminatory practices that limit insurance coverage for behavioral health treatment and services.
Excerpts from this article provided by: http://www.upi.com/Health_News/2013/11/10/Loopholes-closed-that-kept-insured-from-mental-health-therapy/UPI-16151384065630/#ixzz2klkY4k3v