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New rule implements MHPAEA

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WASHINGTON (AP) — The Obama administration today issued new regulations that spell out how it will administer the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).)

Health and Human Services (HHS) 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 MHPAEA, signed by President George W. Bush, was designed to prevent that.

Drafters created the law to create a tougher, more specific version of an earlier federal parity law, the Mental Health Parity Law of 1996.

The MHPAEA does not require employers to offer coverage for mental health or substance abuse, but, if an employer with more than 50 employees does offer mental health or addiction treatment benefits, the financial requirements and treatment limits must be comparable to the requirements and limits for care for other types of disorders.

Mental health advocates say 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 directly affects only large-group plans.

The Patient Protection and Affordable Care Act of 2010 (PPACA) creates a package of essential health benefits (EHB) that individual and small-group plans must offer. When federal agencies developed regulations implementing the EHB package law, they made parity in mental health and substance abuse services part of the package. The regulations mean that, starting in 2014, individual and small-group plans will have to cover mental health issues and addiction problems the same way they cover physical illness.

“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.

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 PPACA.

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.

Allison Bell and Associated Press writer Josh Lederman contributed to this report.

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