WASHINGTON -- President Obama promised Wednesday that his administration would issue final rules implementing a 2008 law that requires insurers to cover mental health services on a par with physical care, but the President gave no time frame for doing so.
The law -- the Mental Health Parity and Addiction Equity Act -- states that if a group health plan covers the treatment of mental illness or drug or alcohol abuse, it cannot charge higher copayments, deductibles, and out-of-pocket expenses for those services than for treatment of physical illnesses.
Companies with fewer than 50 employees in their group insurance plans are excluded from the law.
Groups that pushed for the law have been waiting for the remaining rules holding up its final implementation. Although the Obama administration issued an interim final rule in February 2010 on some quantitative metrics health plans can use to ensure parity between mental health and physical health services -- such as caps on out-of-pocket costs -- it stopped short of specifying nonquantitative treatment limits.
The American Psychiatric Association (APA) praised the inclusion of the parity rules in Obama's proposals to stem gun violence.
"We strongly urge the administration to close loopholes involving so-called 'nonquantitative treatment limits' and to ensure that health plans deliver a full scope of mental health services in order to comply with the law," APA President Dilip Jeste, MD, said in a statement. "Such action will best ensure that Americans get the full range of mental health services we believe they are intended to receive under federal law."
Mental health advocates, including the National Alliance on Mental Illness (NAMI) in Arlington, Va., also said they were pleased the promise was included in the broader gun control proposals.
"That's more than we've had," Andrew Sperling, director of federal legislative advocacy for NAMI, told ڴŮ Wednesday.
The 2010 interim final rule spelled out quantifiable limits such as out-of-pocket caps on mental healthcare, copays, deductibles, and caps on inpatient and outpatient stays. "They've helped enormously in people who are likely to run up on those caps in their plans," Sperling said.
But some areas were still undefined, such as which mental health services are comparable to medical care. For example, insurers don't know where therapy falls in relation to physical healthcare. Also, health plans are unsure which mental healthcare services should be deemed medically necessary, since such services are often less clearly defined compared with traditional medicine.
"But we're really hoping that the final rule will fill in some of the holes," Sarah Steverman, director of state policy for Mental Health America in Alexandria, Va., told ڴŮ.
Until insurers know which mental health services are comparable, "you really can't enforce parity at all," Steverman said.
Sperling said he is "generally confident" that if the Obama administration puts a promise in writing that it will come, despite the fact that advocates have been waiting for almost 3 years for such a rule.
Once rules are issued as Obama has promised, advocacy groups will work to ensure health insurers comply with the law and consumers are aware of their rights.
Steverman cited a survey 2 years ago that found more than 90% of the public was unaware they had a new right to mental health services. "We know there's a lot of education for the public" that still needs to be done, she said.
While not part of the 2008 law, Obama noted the Affordable Care Act (ACA) includes provisions to help mental health coverage parity. Mental health and substance abuse services are part of the 10 essential health benefits all new small group and individual plans must cover under the ACA.
"The administration intends to issue next month the final rule defining these essential health benefits and implementing requirements for these plans to cover mental health benefits at parity with medical and surgical benefits," the in a proposal issued Wednesday containing a number of steps to curb gun violence.