Regulation requires parity from insurers for mental illness coverage


McClatchy Washington Bureau

The Obama administration on Friday issued final rules requiring insurers to cover mental health and substance abuse treatments in the same way that medical and surgical benefits are covered.

The rules require that health plan co-payments, deductibles and coverage restrictions for mental health and addiction services be the same as those for standard medical treatments.

The new guidelines, which apply to nearly all private insurance plans, finalize implementation of the 2008 Mental Health Parity and Addiction Equity Act and will expand treatment services for millions of Americans.

“This final rule breaks down barriers that stand in the way of treatment and recovery services for millions of Americans,” said Health and Human Services Secretary Kathleen Sebelius.

In the aftershock of December’s shooting in Newtown, Conn., when a mentally ill gunman stormed a school and killed 20 children and six adults, Congress and the White House have emphasized better mental health services, among other approaches, as one way to combat gun violence.

Sen. Richard Blumenthal, D-Conn., said the rules were “long overdue” but constitute the “single most important step to stem and stop gun violence since the Newtown tragedy.”

“Countless Americans will be safer and healthier because these rules will enable victims of painful, debilitating and disabling mental health conditions to seek treatment before they actually commit harm to others,” Blumenthal said.

Experts said the expansion of treatment under the new rule also could help curb homelessness and jail overcrowding since the mentally ill account for a disproportionate share of street people and inmates.

More than 45 million U.S. adults suffered from a mental illness in 2011, but just over 17 million of them received treatment, according to a 2012 report by the U.S. Substance Abuse and Mental Health Services Administration.

Likewise, some 23 million Americans have a substance abuse problem, but only 10 percent of them get treatment, said Gil Kerlikowske, director of the Office of National Drug Control Policy.

The new rule does not require group health plans to provide mental health and substance abuse benefits.

Rather, if they do, the new rule requires that those plans’ financial requirements and treatment limitations for mental health and addiction benefits cannot be more restrictive or more generous than the guidelines for most medical and surgical benefits.

The new parity rule applies to non-federal governmental health plans with more than 100 employees, private employer group plans with more than 50 employees, and individual coverage purchased on the new insurance marketplaces.

Group plans of smaller employers with fewer than 50 workers are not subject to the law, according to the Department of Health and Human Services. Medicare and Medicaid programs are likewise not covered by the new guidelines.

Dr. Jeffrey Lieberman, president of the American Psychiatric Association, called the announcement a “historic milestone” that addresses a major disparity in the health insurance market.

“Finally, we have the pieces in place to enable mental health care to be provided more effectively and more fully to people in need,” Lieberman said.

Members of National Guard and military reserve units who served in Iraq and Afghanistan will be some of the main beneficiaries of the new rules, since they rely on job-based health coverage, not Veterans Administration benefits, to treat their post-traumatic stress disorders and other emotional wounds of war.

“That is why these rules are not simply important for all Americans, but they’re of particular importance for our American heroes, and I think that it’s important we continue to keep that in mind as we monitor and as we enforce these rules,” said former Rhode Island congressman Patrick Kennedy, who suffers from mental illness and who worked with his late father, Massachusetts Sen. Edward Kennedy, to pass the 2008 legislation.

Email:; Twitter: @TonyPughDC

Read more Politics Wires stories from the Miami Herald

FILE - This March 14, 2013 file photo shows House Minority Leader Nancy Pelosi of Calif., and House Democratic leaders speaks during a news conference on Capitol Hill in Washington. The House Republicans’ campaign committee raised almost $10 million in March and has $31.2 million banked to defend the party’s majority, according to financial reports filed Sunday. The National Republican Congressional Committee’s $21.2 million fundraising haul in January, February and March gave the group its best first-quarter showing since 2003. It also puts the committee roughly $8 million ahead of its fundraising at this point in 2012. From left to right are Democratic Campaign Committee Chairman Steve Israel, D-N.Y., House Minority Whip Steny Hoyer, D-Md., House Minority Leader Nancy Pelosi, D-Calif., and Democratic Caucus Chairman Xavier Becerra, D-Calif.

    GOP campaign committee has $31M to hold House

    The House Republican campaign committee raised almost $10 million in March and has $31.2 million banked to defend the party's majority, according to financial reports filed Sunday.

First lady Michelle Obama, left, walks with President Barack Obama, and daughters Sasha and Malia, both partially obscured, from the White House to a motorcade to attend Easter services on Sunday, April 20, 2014, in Washington. The first family attended services at the Nineteenth Street Baptist Church in Washington.

    Obama, family cause a small stir at Easter service

    President Barack Obama may have expected a quiet Easter, but his presence rallied a congregation eager to greet him and his family to the front of the church.

Retire U.S. Army Col. Conrad Reynolds participates in a debate between Republican Congressional hopefuls in Little Rock, Ark., Saturday, April 19, 2014. Three area seeking the GOP nomination in the race for Congress in Arkansas' 2nd district.

    3 vying for Republican nomination for House seat

    The three candidates seeking the Republican nomination for a central Arkansas congressional seat are running on vows to cut taxes and regulations in Washington, but split sharply on who would be the strongest candidate in this fall's election.

Miami Herald

Join the

The Miami Herald is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere on the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.

The Miami Herald uses Facebook's commenting system. You need to log in with a Facebook account in order to comment. If you have questions about commenting with your Facebook account, click here.

Have a news tip? You can send it anonymously. Click here to send us your tip - or - consider joining the Public Insight Network and become a source for The Miami Herald and el Nuevo Herald.

Hide Comments

This affects comments on all stories.

Cancel OK

  • Marketplace

Today's Circulars

  • Quick Job Search

Enter Keyword(s) Enter City Select a State Select a Category