New rule demands parity for mental health coverage

KEVIN FREKING, Associated Press

WASHINGTON — It's final: Health insurance companies now must cover mental illness and substance abuse just as they cover physical diseases.

The Obama administration issued new regulations Friday that spell out how a 5-year-old mental health parity law will be administered.

• MPR special report: Minnesota's Mental State

Health and Human Services Secretary Kathleen Sebelius said the rule should put an end to discrimination faced by some mental health patients through higher out-of-pocket costs or stricter limits on hospital stays or visits to the doctor.

The law, signed by President George W. Bush, was designed to prevent that. But mental health advocates said health insurers at times sidestepped lawmakers' intentions by delaying requests for care and putting in place other bureaucratic hurdles. They described the new Obama administration rule as necessary to ensure patients get benefits they are entitled to receive.

The administration had pledged to issue a final mental health parity rule as part of an effort to reduce gun violence. Officials said they have now completed or made significant progress on 23 executive actions that were part of a plan announced in response to the school massacre in Newtown, Conn., last December.

The 2008 mental health parity law affects large group plans. The Affordable Care Act requires individual and small group plans to treat mental health and substance abuse coverage the same way physical illness coverage is treated.

"For way too long, the health care system has openly discriminated against Americans with behavioral health problems," Sebelius said in a telephone conference call with reporters. "We are finally closing these gaps in coverage."

Sebelius said that access to mental health coverage had already been improving since passage of the mental health parity law. She noted that larger employer health insurance plans already have eliminated higher cost-sharing for inpatient mental health care and said most plans have done the same for outpatient care.

HHS officials said mental health services generally amount to only about 5 percent of a large group insurance plan's spending, so there should be limited impact on premiums. They said the small group and individual plans being made available through health insurance exchanges already reflect the parity requirements.

Officials at America's Health Insurance Plans, a trade group, said they were still reviewing the rule.

David Wellstone has carried on his father's advocacy for mental health issues. The law bears former Minnesota Senator Paul Wellstone's name.

David Wellstone said the new rules address directly what services need to be covered.

"Up until this point it's been my thought that there's been some plans and insurance companies that figured, you know what, there's no teeth behind this thing, we're going to continue business as usual," Wellstone said. "That can no longer happen."

Wellstone said people with mental illness may still face barriers to care.

"I have heard that we are really going to putting a stress on the mental health system, so I think we need more, we're going to need more providers as people now realize that they've got this new civil right."

Gil Kerlikowske, director of the National Drug Control Policy Office at the White House, said the rule builds on the need to treat drug problems as a public health issue and not just as a criminal justice issue. He said about 23 million Americans have a substance abuse disorder, but only about 1 in 10 receive the treatment they need.

"Access to drug treatment shouldn't be a privilege to a few who can afford it. It should be provided to everyone who needs it," Kerlikowske said.

Lawmakers instrumental in passing the health parity law had grown impatient with how long it was taking to fully implement it.

"While I am clearly frustrated that this wasn't done sooner, I understand that they had a lot of other things on their plate," said former Rep. Patrick Kennedy, D-R.I., adding that it would be ungrateful not to take into account progress made on other fronts through the Affordable Care Act.

Kennedy went public about his own struggle with addiction after crashing his car into a barricade near the Capitol in 2006; he was diagnosed with bipolar disorder after winning election to Congress in 1994.

"Ending insurance discrimination against pre-existing conditions is the single biggest mental health bill we could get," Kennedy said.

MPR News' Tom Crann and Jon Collins contributed reporting