Rules: Mental, Physical Ailments to Be Insured
Washington — The Obama administration on Friday issued final rules requiring insurers to cover mental health and substance abuse treatments in the same way that medical and surgical benefits are covered.
The rules require that health plan co-payments, deductibles and coverage restrictions for mental health and addiction services be the same as those for standard medical treatments.
The new guidelines, which apply to nearly all private insurance plans, finalize implementation of the 2008 Mental Health Parity and Addiction Equity Act and will expand treatment services for millions of Americans.
“This final rule breaks down barriers that stand in the way of treatment and recovery services for millions of Americans,” said Health and Human Services Secretary Kathleen Sebelius.
In the aftershock of December’s shooting in Newtown, Conn., when a mentally ill gunman stormed a school and killed 20 children and six adults, Congress and the White House have emphasized better mental health services, among other approaches, as one way to combat gun violence.
Sen. Richard Blumenthal, D-Conn., said the rules were “long overdue” but constitute the “single most important step to stem and stop gun violence since the Newtown tragedy.”
“Countless Americans will be safer and healthier because these rules will enable victims of painful, debilitating and disabling mental health conditions to seek treatment before they actually commit harm to others,” Blumenthal said.
Experts said the expansion of treatment under the new rules also could help curb homelessness and jail overcrowding since the mentally ill account for a disproportionate share of street people and inmates.
More than 45 million U.S. adults suffered from a mental illness in 2011, but just over 17 million of them received treatment, according to a 2012 report by the U.S. Substance Abuse and Mental Health Services Administration.
Likewise, some 23 million Americans have a substance abuse problem, but only 10 percent of them get treatment, said Gil Kerlikowske, director of the Office of National Drug Control Policy. The new rule does not require group health plans to provide mental health and substance abuse benefits.
Rather, if they do, the new rule requires that those plans’ financial requirements and treatment limitations for mental health and addiction benefits cannot be more restrictive or more generous than the guidelines for most medical and surgical benefits.
The new parity rule applies to non-federal governmental health plans with more than 100 employees, private employer group plans with more than 50 employees, and individual coverage purchased on the new insurance marketplaces.
Group plans of smaller employers with fewer than 50 workers are not subject to the law, according to the Department of Health and Human Services. Medicare and Medicaid programs are likewise not covered by the new guidelines.
Dr. Jeffrey Lieberman, president of the American Psychiatric Association, called the announcement a “historic milestone” that addresses a major disparity in the health insurance market.
“Finally, we have the pieces in place to enable mental health care to be provided more effectively and more fully to people in need,” Lieberman said.
Members of National Guard and military reserve units who served in Iraq and Afghanistan will be some of the main beneficiaries of the new rules, since they rely on job-based health coverage, not Veterans Administration benefits, to treat their post-traumatic stress disorders and other emotional wounds of war.
“That is why these rules are not simply important for all Americans, but they’re of particular importance for our American heroes, and I think that it’s important we continue to keep that in mind as we monitor and as we enforce these rules,” said former Rhode Island congressman Patrick Kennedy, who suffers from mental illness and who worked with his late father, Massachusetts Sen. Edward Kennedy, to pass the 2008 legislation.