New federal regulations have been published, mandating that group health insurance plans provide benefits for mental health and addiction services equal to benefits for medical and surgical services. The proposed interim final rule expands upon the Mental Health Parity Act of 1996.
The rules, which take effect July 1, forbid higher copayments or deductibles or separate deductibles for mental health and addiction treatments. Insurers will retain the ability to review claims for "medical necessity," require prior approval for some services and charge patients more for seeking treatment from providers not included on preferred lists. However, the new rules would forbid insurers from using these tactics in a more restrictive way for mental health care than for other medical services.
The rules apply only to public or private employer health plans that currently offer mental health benefits and that cover 50 or more employees. However, there is no requirement for health plans to cover mental health and addiction treatment, and the rules do not stipulate which conditions must be covered. The rules do not apply to group health plans with fewer than 50 employees or insurers that sell individual coverage plans.
Comments on the interim final regulation are due by May 3, 2010.