On November 8, 2013 the Departments of Health and Human Services, Treasury, and Labor issued the final mental health parity rule that requires plans that offer mental health and substance use benefits not restrict those benefits more than the medical and surgical benefits also offered. The rule does not require health plans to cover mental health or substance use services, but states that those plans that do so, must comply with these new rules.
These mental health parity provisions apply for plan years beginning on or after July 1, 2014, and only applies to self and fully insured employer-sponsored plans with 50 or more employees. However, because the Affordable Care Act requires some individual and small group health plans to cover mental health and substance use benefits as an essential benefit in 2014, the rules are expanded.
Now, out-of-pocket costs and treatment limitations cannot be more restrictive in mental health and substance use benefits than in medical and surgical benefits. The final rules require that if medical and surgical benefits are offered out-of-network, then mental health and substance use benefits must also be offered out-of-network. Plans must make medical necessity determinations and reasons for denial available to participants. Lastly, the rules require parity in all levels of care and plan standards.