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Health Care: Parity Update

US Capitol

For many group health plans, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act went into effect on January 1. The new law requires most group health plans to cover treatment for mental illness and substance use disorders on the same terms and conditions as medical conditions such as diabetes, heart disease, cancer and asthma. Specifically the new law bars health plans from imposing durational treatment limits (caps on inpatient days or outpatient visits) or financial limitations (higher cost-sharing, deductibles or out of pocket limits) that do not also apply to medical-surgical coverage.

The effective date of the new law is actually the beginning of the first new plan year after Oct. 3, 2009. The new law applies to all group health plans sponsored by employers with 50 or more workers.

Parity Regulations Expected Soon

The Obama Administration is in the process of issuing interim final regulations implementing the new law and setting forth specific standards for how group health plans are to eliminate restrictions on mental illness treatment coverage and ensure equity with respect to application of managed care practices and scope of services.

Last spring NAMI submitted detailed comments to the various federal agencies charged with implementing and enforcing the new law (the Departments of Health and Human Services, Labor and Treasury) in response to a "Request for Information."


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