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Loopholes closed that kept insured from mental health therapy

Nov. 10, 2013 at 1:40 AM   |   Comments

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BETHESDA, Md., Nov. 10 (UPI) -- U.S. government agencies say they closed the loopholes that kept insured patients from being treated for mental illness or substance abuse.

"This final rule breaks down barriers that stand in the way of treatment and recovery services for millions of Americans," Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, said in a statement.

The U.S. Departments of Health and Human Services, Labor and Treasury jointly issued a final rule Friday 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 -- tagged on the Troubled Asset Relief Program and signed into law by President George W. Bush in October 2008. It ensures health plan features such as 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.

In 1996, the Mental Health Parity Act required annual or lifetime caps on mental health benefits be no lower than caps for medical and surgical benefits offered by a group health plan or health insurance issuer. Before this law, health insurance coverage for mental illness was spotty and treatment was limited.

However, once the 1996 law was approved, insurers effectively restricted treatment by implementing caps on the number of days an insurer would cover treatment visits, and by requiring higher co-pays, deductibles and out-of-pocket maximums.

"This final rule breaks down barriers that stand in the way of treatment and recovery services for millions of Americans," Sebelius said. "Building on these rules, the Affordable Care Act is expanding mental health and substance use disorder benefits and parity protections to 62 million Americans. This historic expansion will help make treatment more affordable and accessible."

In addition to treating mental illness insurance coverage the same as insurance coverage for a physical illness, the new rule requires insurance coverage for substance use.

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.

The final Mental Health Parity and Addiction Equity Act rule was developed based on the departments' review of more than 5,400 public comments on the interim final rules issued in 2010.

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