Mental Health Parity Rules Released

New regulations implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, or MHPAEA, were released in February.

According to NASW lobbyist James Finley, the final rules were based on a review of more than 400 comments, including those made by NASW as a member of a coalition of mental health groups.

The rules require that group health plans that offer mental health and addiction benefits along with medical and surgical benefits “must treat them equally in terms of out-of-pocket costs, benefit limits and practices, such as prior authorization and utilization review,” Finley said in a February advocacy report.

While the regulations have been published by the Department of Health and Human Services, a comment period has been extended to May 3, Finley noted. The effective date is for insurance plans that begin on or after July 1.

“NASW is working now on comments,” Finley said.

So far, MHPAEA contains several limitations. It lacks a mandate that mental health and addiction benefits be offered by every plan and the law does not specify which conditions must be covered, Finley explained.

The law is also limited in that it applies only to public or private employers with 50 or more workers, including both self-insured and fully insured entities. Group health plans for companies with fewer than 50 employees are exempt from the regulations.

It is estimated that 160 million residents are covered in large employers’ group health plans.

There is good news to highlight as well, Finley said.

“At this early time, mental health groups report they have seen no significant trend of employers eliminating coverage for behavioral health benefits as a way to avoid implementing parity requirements,” he said.

Another benefit of the new law is that it extends protections to substance use disorder benefits and it greatly expands on the Mental Health Parity Act of 1996.

“NASW spent years advocating for the legislation along with a large coalition of mental health and substance abuse treatment advocacy organizations,” Finley said. The late Sen. Edward Kennedy, D-Mass., former Sen. Pete Domenici, R-N.M., former Rep. Jim Ramstad, R-Minn., and Rep. Patrick Kennedy, D-R.I., have been recognized as longtime champions of supporting mental health parity.

More information is available by visiting the Centers for Medicare and Medicaid Services.