Congressman Jim Himes (CT-4) announced today that the Department of Health and Human Services has finalized a rule increasing parity between mental health disorder benefits and medical/surgical benefits in group and individual health plans. This will help ensure that co-pays, deductibles, and visit limits are not more restrictive for mental health and substance abuse disorder benefits than they are for medical and surgical benefits.
"I am extremely pleased that this rule is being put into effect to bring mental health service benefits in line with the health benefits already enjoyed by millions of Americans," said Himes. "This important rule will help end the stigma associated with mental illness and help those suffering from mental illness get the help they need so that tragedies like Sandy Hook never happen again."
The rule is one of 23 executive actions outlined by President Obama in January to reduce gun violence in the wake of the Sandy Hook shooting. In addition to ensuring parity for mental health services, the new rule will also:
Ensure that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings;
Clarify the scope of the transparency required by health plans, including the disclosure rights of plan participants;
Clarify that parity applies to all plan standards, including geographic limits, facility-type limits and network adequacy; and
Eliminate a provision that allowed insurance companies to make an exception to the non-quantitative treatment limitation (NQTL) parity requirements for certain benefits based on "clinically appropriate standards of care," which clinical experts advised was not necessary and which provided a potential loophole.