New Parity Rules Reinforce Protections for Coverage of Mental Health, Substance Use
Dec 03, 2013
By: Donald B. Moulds, Acting Assistant Secretary for Planning and Evaluation, Health and Human Services
On November 13, the final rule was published for the Mental Health Parity and Addiction Equity Act (Parity Act).
The Parity Act makes it easier for Americans to get the care they need by prohibiting certain discriminatory practices that limit coverage for mental health and substance use disorder treatment and services.
The Parity Act generally requires that, when offered, health insurance coverage for mental and substance use disorder benefits is no more restrictive than benefits for physical health conditions.
ACA, Parity Act Protections
The Affordable Care Act (ACA) and the Parity Act support an historic expansion of insurance coverage for the care of mental and substance use disorders. Through the Affordable Care Act, 32.1 million Americans will gain access to coverage that includes mental health and/or substance use disorder benefits.
An additional 30.4 million Americans who currently have some insurance coverage for mental health and substance use disorder benefits will gain federal parity protections.
In total, the two Acts will newly extend federal parity protections to more than 62 million Americans.
Parity Act Details
Under the Parity Act, coverage of treatments and services for mental health conditions or substance use disorders generally must have:
- Copayments (amount you pay when you go to a doctor’s office or receive another health service) and coinsurance (percentage you pay above what your insurer covers) that is comparable to those for physical health services.
- Limits on services use -- such as limits on the number of inpatient days or outpatient visits covered, which are no more stringent than limits applied to physical health services.
- Criteria for managing care that are no more stringent for mental and substance use disorder services than physical health services. For example, approval from your health insurance provider before you can receive a service.
Because of the ACA, starting in 2014, most health insurance coverage sold to individuals or offered by smaller employers must cover mental health and substance use disorders benefits and comply with the Parity Act.
The Parity Act itself does not require insurance plans to cover mental health or substance use disorder benefits, but most large private employer plans do. When these large private employers provide this coverage, they must meet the requirements of the Parity Act.
The final rule for the Parity Act also clarifies disclosure requirements for health plans, so that people can be better informed about health plan management of mental health and substance use disorder benefits and compare it to the management of physical health benefits.
If you have additional questions regarding compliance with the Parity Act, you may contact
- Department of Health and Human Services at 1-877-267-2323 extension 6-1565 or phig@cms.hhs.gov
- Department of Labor’s regional offices or 1-866-444-3272
Regardless of which number you call, the Federal Departments will work together and with States to ensure Parity Act violations are corrected.
Additional Resources
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