Three federal agencies have finalized long-awaited mental health parity regulations, expanding group and individual access to substance abuse services and with it, spending.
In an announcement earlier this month, the Health, Labor and Treasury departments unveiled the final rules for the 2008 Mental Health Parity and Addiction Equity Act, expanding mental health parity to substance abuse and requiring equal co-pays and deductibles for mental and physical health services.
Along with Affordable Care Act provisions, the rules finalize guaranteed access to behavioral health services for both group health plan members and individual policyholders.
After receiving some 5,000 comments on the preliminary rule for the parity law in 2010, the agency's final regulation establishes rules for access to residential treatment or outpatient services, the scope of patient rights disclosures and network adequacy, among other provisions.
The agencies also eliminated a previous exception for discretion in limiting coverage not deemed within "clinically appropriate standards of care" for mental and substance abuse, but allowing that type of nonquantitative treatment limitation if its evidence framework for mental health and substance abuse is comparable to medical and surgical guidelines.
Many health plans are already in compliance with many of the provisions, and probably few will have to use a cost increase exemption allowed under the rule. But the established parity in combination with newly insured is likely to spark slightly more utilization, with the Treasury Department estimating that the law as a whole may lead to a 0.6 percent increase in national health spending.
The agencies also noted that the final rules come as one way that the Obama Administration is addressing the problem of gun violence, "as part of a larger effort to increase access to affordable mental health services and reduce the misinformation associated with mental illness."
And the final rule coincided with the 50th anniversary of the Community Mental Health Act and the move away from institutionalization, and comes at the same time as problems in current behavioral health models, especially the challenge of housing.
A recent investigation into a 251-bed residential facility in Tom's River, New Jersey, found unsanitary conditions, drug use, and disengaged staff. "It can only be described as pandemonium," Robert Davison, a mental health advocate who checked himself into the facility under a fake name, told public radio station WHYY.