On November 8, 2013, the Departments of HHS, Labor, and Treasury jointly issued a final rule implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA).  The MHPAEA requires group health plans and health insurance issuers to ensure that financial requirements such as co-pays, deductibles and treatment limitations (such as visit limits) applicable to mental health and substance use disorder benefits are no more restrictive than the limitations applied to medical and surgical benefits.  The rule finalizes interim final regulations published in the Federal Register on February 2, 2010, and is effective for plan years beginning on or after July 1, 2014.

According to a Center for Consumer Information & Insurance Oversight fact sheet, the law applies to large group health plans.  It does not apply to small group health plans nor does it require large group health plans to cover mental health and substance use disorder benefits.  Moreover, as noted in the fact sheet, Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) are not group health plans.  However, CHIP plans, Medicaid Benchmark Benefit plans, as well as managed care plans that contract with State Medicaid programs to provide services are subject to certain requirements of MHPAEA. 

To view the final rule, please click here.   

Reporter, Lora L. Greene, New York, +1 212 556 2174, lgreene@kslaw.com.