Updated Parity Regulations Defend Right to Access, Enhance Addiction Treatment

HARTFORD — Kevin Lembo, state healthcare advocate, heralded new federal mental health parity regulations that went into effect on July 1. The regulations implement the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.

The MHPAEA makes sweeping reforms to the previous federal mental health parity law of 1996 and offers brand-new protections to consumers in Connecticut.

“OHA is committed to ensuring that consumers know about these new protections available to them under the MHPAEA,” Mr Lembo said. “As insurers and employers make the necessary changes to comply with the new law, consumers also need to have up-to-date information so they preserve their rights to access medically necessary mental health care.”

The regulations require parity between mental health or substance use disorder benefits and medical/surgical benefits with respect to financial requirements and treatment limitations.

For the first time, the federal government has issued regulations that reach for real mental health parity. Plans are not only prohibited from imposing different financial requirements on mental health access, like co-pays and deductibles, but plans cannot arbitrarily limit the number of mental health visits a consumer can make.

Nor can a plan put greater restrictions on mental health access than on medical/surgical access, like excessive prior authorization requirements, restrictions on access to medications, and types of services, like outpatient or inpatient treatment.

“Every group health plan in Connecticut has an obligation to inform its consumers and provider panels of these new federal regulations,” Mr Lembo concluded. “The successful implementation of these protections is vital and potentially life saving.”

Addiction Treatment

As a result of the updated regulations, addiction treatment centers will be able to help more people in need of substance abuse treatment, especially those in college. With a new law, insurers will be required to provide equal insurance coverage for people with substance abuse disorders seeking assistance.

According to the U.S. Department of Health and Human Services Secretary Kathleen Sebelius, the rules will, 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.

“I applaud the long-standing and bipartisan effort that made these important new protections possible,” said Secretary Sebelius.

The MHPAEA requires all group health plans including mental health and substance use disorder benefits to treat these benefits the same as the medical and surgical benefits. Out-of-pocket cost, benefit limits and practices such as prior authorization and utilization review for substance abuse problems should be no more restrictive than those requirements for medical and surgical benefits.

Paired with the new health care laws, the MHPAEA will allow for more college students to get the help they need with only a minimal cost. With the new health care bill, students can stay on their parent’s insurance until they are 26, giving them more time to get the help they may need.

Most At Risk

College students are one of the most at risk age groups to develop an addiction because of all the freedom and opportunity to experiment. This pairing of new laws will give The Watershed the opportunity to help more of these college students who have fallen to the disease of addiction.

The parents of these college students will be able to provide the necessary health insurance coverage that these students need. The coverage that the parents of these college students have will range from the number of employees that work at the company to whether the company is publicly or privately held. The new MHPAEA applies to both public and private employers who have more than 50 employees. It will also apply to health insurance providers who sell coverage to employers.

The new additions to the Mental Health Parity Act created new opportunities for those in need of help with substance abuse problems.

Mr Lembo said that the OHA has posted additional information on its website, www.ct.gov/oha. Consumers with questions can call 866-466-4446.