Reform that Affects Mental Health, Addiction
For those enrolled in employee-provided group health plans, receiving treatment for diagnosed substance use or mental health disorders will soon become easier, or at the very least, less costly.

Under President Barack Obama, the Health & Human Services, Labor and Treasury Departments in January issued new regulations to the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Those rules, which went into effect for new plans on July 1st, according to the CMS' Division of Private Health Insurance, prevent group health insurance plans from limiting benefits or requiring higher out-of-pocket patient costs than what would be expected from patients accessing medical or surgical benefits. The effective date for already existing calendar-year plans is January 1st, 2011.

These "rules will bring needed relief to families faced with meeting the cost of obtaining mental health and substance abuse services," said U.S. Labor Secretary Hilda L. Solis, in a news release. "The benefits will give these Americans access to greatly needed medical treatment, which will better allow them to participate fully in society. That's not just sound policy, it's the right thing to do."

Some politicians have felt that way for decades. The parity issue dates back to John F. Kennedy's presidency, with more recent support shown from the late Senator Edward Kennedy and President Bill Clinton. The MHPAEA, also known as the Wellstone-Domenici Act, is named after the late Senator Paul Wellstone, an advocate for equal benefits treatment, and former Senator Pete Domenici, who introduced the legislation in 1992.

The MHPAEA and the recent additional regulations are expansions on the Mental Health Parity Act of 1996, which did not include substance use disorder benefits. The 1996 law also called for equality only in annual and lifetime dollar limits between benefit categories.

The revised 2008 law calls for parity in terms of prior authorization and utilization review requirements, out-of-pocket costs and benefit limits. Deductibles and co-payments may not be separately applied to mental health or substance use disorders—they must be equal to the cost of medical and surgical limits and payments.

However, the MHPAEA does not cover all of those who seek behavioral health treatment. Individual plans and small group health plans (employers who have between 2 and 50 employees) are exempt from the rules, as are plans that do not offer mental health benefits.

If your insurance plan does not meet MHPAEA requirements, you can check your state's laws for additional protection. According to the National Conference of State Legislatures, at least 38 states have laws that include substance abuse, drug and alcohol addiction coverage, and forty-nine states and Washington, D.C., have some type of mental health benefits law.

For more information visit the U.S. Department of Health & Human Services Web site or call the Centers for Medicare & Medicaid's help line if you have questions about your employer-provided plan's compliance with MHPAEA at 1-877-267-2323, ext. 6-1565.