The Departments of Health and Human Services, Labor and the Treasury issued a final rule that increases parity between mental health/substance use benefits and medical/surgical benefits in group and individual health plans.
Under the final rule, co-pays, deductibles, and visit limits cannot be generally no more restrictive for mental health/substance abuse disorders benefits than they are for medical/surgical benefits.
The rule also includes these consumer protections:
• Ensures that parity applies to intermediate levels of care in residential treatment or intensive outpatient settings.
• Clarifies how much transparency health plans must have, including disclosing the rights of plan participants.
• Clarifies that parity applies to all plan standards, including geographic limits, facility-type limits, and network adequacy.
• Eliminates a provision that allowed insurance companies to make an exception to parity requirements for certain benefits based on “clinically appropriate standards of care.” Clinical experts have said that this exception was not necessary, was confusing, and was open to abuse.
In January, as part of the President and Vice President’s plan to reduce gun violence, the Administration committed to finalize this rule as part of a larger effort to increase access to affordable mental health services and reduce the misinformation associated with mental illness.
