Work needed to close gaps in coverage for mental health, substance abuse treatment

Mental health advocates praised a long-awaited final rule issued Friday by the Obama administration requiring insurers to cover mental healthcare on the same basis as physical healthcare services. But they cautioned that more work is needed before full parity is achieved.The final rule, issued jointly by HHS and the Treasury Department, ensures that health plans covering about 85% of the population offer the same deductibles, copayments and limits on visits for mental health services as offered for medical and surgical services.

The rule implements the provisions of the landmark 2008 Mental Health Parity and Addiction Equity Act. It takes effect July 1, 2014. It combines with the Patient Protection and Affordable Care Act to offer an unprecedented level of coverage for people with mental healthcare needs. The ACA includes mental health services among the 10 essential benefits that must be offered by all insurance plans starting in January.

The new rule applies parity requirements to intermediate levels of care in residential treatment and intensive outpatient settings. It also clarifies that parity applies to limits on geography and types of facilities in provider networks and eliminates a provision that allowed insurance companies to make exceptions based on “clinically appropriate standards of care.” Other protections in the final rule require insurers to transparently disclose the rights of plan participants.The law and the rule do not apply to Medicare and traditional state-run Medicaid, but the administration had previously instructed state officials that their Medicaid programs should meet the 2008 parity law requirements. The law does apply to Medicaid managed-care plans, though the administration is expected to issue separate guidance for those plans, said Chuck Ingoglia, senior vice president for public policy at the National Council for Behavioral Health.

“For way too long the healthcare system has openly discriminated against Americans with behavioral health problems,” HHS Secretary Kathleen Sebelius said on a call Friday with reporters. “We are finally closing these gaps in coverage.”