The U.S. government has published proposed new rules on mental health insurance parity that would prohibit health insurance plans from restricting access to care by limiting benefits and requiring higher patient costs than other treatments.

The rules would apply to group health plans whose employer has at least 50 workers and seek to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addition Equity Act of 2008. The new rules, if not modified, are scheduled to take effect with plan years beginning July 1.

The U.S. Departments of Labor, Health and Human Services (HHS), and the Treasury jointly issued the rules, which expand on the Mental Health Parity Act of 1996, requiring parity only in aggregate lifetime and annual dollar limits between the categories of benefits and did not extend to substance use disorder benefits.

“Today’s rules will bring needed relief to families faced with meeting the cost of obtaining mental health and substance abuse services,” said U.S. Secretary of Labor Hilda L. Solis said Jan. 29 in a statement. “The benefits will give these Americans access to greatly needed medical treatment, which will better allow them to participate fully in society. That is not just sound policy, it’s the right thing to do.”

Kathleen Sebelius

HHS Secretary Kathleen Sebelius said the rules, “for the first time, help assure that those diagnosed with these debilitating and sometimes life-threatening disorders will not suffer needless or arbitrary limits on their care.” She applauded the bipartisan effort that led to their passage.

The new law requires that any group health plan that includes mental health and substance use disorder benefits along with standard medical and surgical coverage must treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review. These practices must be based on the same level of scientific evidence used by the insurer for medical and surgical benefits.

For example, a plan may not apply separate deductibles for treatment related to mental health or substance use disorders and medical or surgical benefits. They must be calculated as one limit. The new law applies to employers with 50 or more workers whose group health plans choose to offer mental health or substance use disorder benefits. The new rules are effective for plan years beginning on or after July 1, 2010.

The late Sen. Paul Wellstone (D-Minn.), who was a vocal advocate for parity throughout his Senate career, sponsored the ultimately successful full parity act. He was joined by former Sen. Pete Domenici (R-N.M.), who first introduced legislation to require parity in 1992. Champions of the legislation also included the bipartisan team of Rep. Patrick Kennedy (D-R.I.) and former Rep. Jim Ramstad (R-Minn).

The interim final rules were developed based on the agencies’ review of more than 400 public comments on how the parity rule should be written. Comments on the interim final rules are still being solicited.