A landmark moment for mental health coverage has taken place. The U.S. Department of Health and Human Services (HHS) issued a long-awaited “final rule” dictating that mental health be covered equal to physical health. The rule finally provides the clarity that is needed to move forward in implementing mental health parity. This is the final aspect of the Mental Health Parity and Addiction Equity Act that was signed into law in 2008.
One important feature of the rule is that it requires insurers to have financial limits (co-payments, deductibles and other out-of-pocket expenses) equal to those of physical conditions. The rule also makes it clear that treatment visits for mental health and substance abuse have no greater limitations than for other medical conditions.
Additionally, the rule requires equity in the criteria that insurers use to make decisions about care. For example, insurers cannot use criteria for denying or limiting inpatient psychiatric treatment that are any more stringent than criteria used for other forms of inpatient medical treatment.
The rule requires insurers to be forthright and transparent about the criteria they use to approve or deny care. This is fundamentally important for individuals and families to navigate the complexities of insurance.
Finally, the new rule makes it clear that parity applies not only to medical treatment but also to vital services and supports essential for many in recovery, including rehabilitative services, case management and residential treatment.
"This final rule breaks down barriers that stand in the way of treatment and recovery services for millions of Americans," said HHS Secretary Kathleen Sebelius. "Building on these rules, the Affordable Care Act is expanding mental health and substance use disorder benefits and parity protections to 62 million Americans. This historic expansion will help make treatment more affordable and accessible."
However, it is important to note that issues remain that will need to be resolved and details need clarification.
NAMI is disappointed that the federal government has not yet indicated how parity requirements apply to managed care plans offered through Medicaid and the Children’s Health Insurance Program (CHIP). The Administration has promised that they will issue guidance on this important topic in the near future. This is critically important because millions of people living with mental illness are covered through these plans.
Currently, 60 percent of Americans affected by a mental health condition do not receive treatment. With rules requiring parity, we hope that more Americans will receive the care they need and deserve.
NAMI Executive Director Michael J. Fitzpatrick reiterated the significance of these rules in a statement earlier today. “The regulations are a crowning achievement. They are the result of a 20-year bipartisan campaign by individuals and families affected by mental illness to end unfair discrimination.”
NAMI will provide further information and guidance about the new rule in the coming days and weeks—but today is a day to celebrate
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