New Rules Define Implementation of Mental Health and Addiction Parity

February 9th, 2010 | Posted by in Addiction | Policy

It’s been a very long road, but the addiction and mental health fields have cleared another hurdle with the recent release of federal rules that define how mental health and addiction parity must be implemented.

Interim final rules jointly issued by the U.S. Treasury Department, the U.S. Department of Labor (DOL) and the U.S. Department of Health and Human Services (HHS) prohibit group health insurance plans that offer mental health and substance use disorder benefits from restricting access to care by limiting benefits or requiring higher out-of-pocket costs than those that apply to general medical and surgical coverage (75 Fed. Reg., 5410-5451). The new rules, which implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), apply to employers with 50 or more workers whose group health plan chooses to offer mental health or substance use disorder benefits, and are effective April 5, applicable to insurance plan years beginning on or after July 1, 2010.

The new rules, issued Feb. 2, enforce requirements with regard to quantitative and non-quantitative treatment limits for mental health and substance use disorders, which may be “applied no more stringently” than those for medical or surgical coverage. Quantitative treatment limits are numerically imposed, such as limits on the number of outpatient visits or number of days spent inpatient at a treatment facility. Non-quantitative limits are other provisions that may affect the scope or duration of benefits under the plan, including: medical management standards, such as preauthorization and case review; determination of usual and customary and reasonable amounts; and requirements for using low-cost therapies before the plan will cover more expensive therapies.

Additionally, the rule specifies six classifications of benefits: inpatient in network; inpatient out-of-network; outpatient in network; outpatient out-of-network; emergency care; and prescription drugs. Basically, if a plan provides any benefits for a mental health condition or substance use disorder under, benefits must be provided for that condition or disorder in each classification for which any medical surgical benefits are provided, according to the rule.

Comments on the interim final regulation are due by May 3, 2010, and may be emailed to the federal rulemaking portal at: Comments will be shared among the three agencies, and therefore, should be submitted only once to one of the following agencies, and should include the appropriate file code: for HHS, CMS-4140-IFC; for DOL, RIN 1210-AB30; for the Treasury’s Internal Revenue Service, REG-120692-09.

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