It’s been a long wait, but today the federal government took a big step toward reducing discrimination that prevents access to treatment for people with substance use disorders and mental illness. The Obama administration issued final regulations implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, which was signed into law in 2008 and strengthened in the Affordable Care Act.
The law bars most health insurance plans from imposing greater restrictions on care for substance use disorders and mental illness than are imposed on treatments for physical ailments such as cancer or heart disease. For example, it prohibits plans from limiting the number of days covered for inpatient treatment for drug addiction if it doesn’t limit hospital days for cancer treatment. These kinds of limits and many others have made it difficult for consumers to get the care they need.
The regulations spell out how the law should be implemented and expand consumer protections by applying the law to residential treatments, intensive outpatient care, and to adequacy of the provider network and what is considered in-network or out-of-network care. For example, now plans cannot exclude coverage of treatment outside of a hospital setting for substance use disorders unless they also exclude it for physical illnesses. Health insurers are also required to provide more transparency about their decisions to enable consumers and their advocates to determine if policies violate the parity law.
All of this is great news for the more than 60 million Americans who have substance use disorders or mental illness. Millions of consumers will get access to insurance coverage for these conditions for the first time on January 1, when new Medicaid and private insurance coverage begins thanks to the ACA. The ACA requires those new plans to provide coverage for substance use disorders and mental illness, and to abide by the parity law.
Having the regulations in hand should also make it easier to enforce the parity law, which has been a consistent problem. While the parity law was enacted in 2008, many insurers still don’t follow the rules. State advocates can play an important role by encouraging their state insurance commissioners to be active enforcers of the law.
We’ll be sharing more information about the regulations in the coming weeks as we and others analyze the details. For now, let’s send up a big cheer!