New mental health coverage rules promise to end some discrimination

Jan 31 2010

Reuters: Employer-provided group health plans must offer the same level of coverage for mental illness and drug abuse treatment as for other ailments, according to federal regulations issued on Friday. The measures, known as mental health parity, ban group health plans from applying different coverage standards for mental health disorders or substance abuse treatment than those for general medical treatment or surgery. (Allen, 1/29).

The Associated Press/ABC News reports the rules prohibit "separate annual deductibles for mental health treatment. And copayments for visiting a psychiatrist or social worker can't be more than the charge for going to the family doctor or a medical specialist. 'Health plans will be under an obligation to provide the same level of coverage for treatment of mental illness as they do for cancer, diabetes and heart disease,' said Andrew Sperling of the National Alliance on Mental Illness. The rules, which take effect July 1, provide a blueprint for employers to carry out a law passed by Congress in 2008 with broad bipartisan support" (1/29).

Medscape:  "The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 ... expands on the Mental Health Parity Act of 1996, which required parity in lifetime benefits for mental and physical disorders and was not applicable to substance use disorder benefits" (Hitt, 1/29).

The New York Times: "By sweeping away such restrictions, doctors said, the rules will make it easier for people to obtain treatment for a wide range of conditions, including depression, autism, schizophrenia, eating disorders and alcohol and drug abuse. For decades, many health plans have had limits on hospital inpatient days and outpatient visits for mental health treatments, but not for other types of care. Kathleen Sebelius, the secretary of health and human services, said the rules guaranteed that people with debilitating mental disorders would not suffer 'needless or arbitrary limits on their care'" (Pear, 1/29).

Winston-Salem Journal: "About 140 million Americans in more than 450,000 employer plans will benefit from improved coverage, according to the administration." The Journal notes that "the act does not require that a group health plan provide benefits for mental health and substance abuse. It also does not apply to issuers who sell health-insurance policies to employers with 50 or fewer employees or who sell health-insurance policies to individuals" (Craver, 1/30).

KTVU (San Francisco): "Advocates are especially happy to see that health plans won't be able to set limits on number of visits or hospital days for mental health care, when those limits don't apply to other ailments. 'I think by going to a doctor and getting the help you need, we get to be more 'out in the world', and not hide ourselves because of the stigma. And we also get to flourish by taking care of ourselves as best we can,' said [Susie] Frank," of the self-help group "Circle of Friends." (1/30).