Final Parity Rule Issued

Scales of JusticeOn Friday, November 8, the Departments of Health and Human Services, Labor and the Treasury issued the final rule to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act.

The final rule includes specific additional consumer protections, such as:

  • Ensuring that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings;
  • Clarifying the scope of the transparency required by health plans, including the disclosure rights of plan participants, to ensure compliance with the law;
  • Clarifying that parity applies to all plan standards, including geographic limits, facility-type limits and network adequacy; and
  • Eliminating an exception to the existing parity rule that was determined to be confusing, unnecessary and open to abuse.

The Substance Abuse Mental Health Services Administration (SAMHSA) has developed a web page that provides links to related resources including links to the final rule, fact sheets, a SAMHSA webinar on parity, and links to frequently asked questions.

http://beta.samhsa.gov/health-reform/parity

See related article on parity from Behavioral Healthcare: Strong final rule for parity means big strides for residential, out-of-state treatment available at: http://www.behavioral.net/article/strong-final-rule-parity-means-big-strides-residential-out-state-treatment

Source: The Substance Abuse Mental Health Services Administration – November 8, 2013

Comments

  1. Chris Nolan says

    MAT providers can take some encouragement from the final rule with respect to evidentiary parity for NQTL’s, but insurers’ ignorance–sometimes willful, especially among subcontracted behavioral health care managers who ought to know better–of the evidence base for methadone and buprenorphine maintenance means that providers will have to continue educating them, fighting claims denials, and setting precedents in the courts.

    Incidentally, the DHHS rulemaking process for PPACA (see regulations.gov) seems to avoid addressing MAT NQTL’s directly, deferring to the individual states with little or no insistence on an evidentiary basis for states’ determinations of what plans on the exchanges must cover.

    I’d like to see more discussion of these concerns, and if anyone’s got information that contradicts my statements above, I would be grateful to see it.

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