Mental Health Care Coverage Changes

Mental Health Care Coverage Changes

People who require mental health coverage are happy to know that long awaited changes to the laws effecting insurance coverage have finally arrived.  Those changes can be found in the new Affordable Care Act, (the “ACA”) and changes made to the Mental Heath Parity and Addiction Equity Act of 2008 (the “Parity Act”).

Under the ACA, among the various types of coverage which must be afforded by insurance companies to their insureds is mental health and substance abuse treatments.  Such coverage is considered “essential” benefits” under the ACA, and must be offered to the public regardless of whether the need for such services arose prior to coverage.

New rules aimed at adding “teeth” to the Parity Act were issued last November.  The law provides that insurance plans must provide coverage for mental ailments in “parity” with other physical ailments.  For example, plans may not set higher deductibles or charge higher co-payments  for mental health coverage than for medical coverage.   Further, plans may not charge higher co-payments for mental health care, nor restrict the number of visits a patient may make for medical health care needs.  The rules go into effect on July 1, and the insurance companies will have until July 1, 2015 to comply.

The most recent rules related to the Parity Act fill in gaps about how the law must be applied, advocates say. For example, plans may not limit mental health care to a specific geographic area, if they do not do so for physical illnesses. And the rules clarify that the law also applies to “intermediate” treatment options for mental health and addiction disorders, benefiting those who require residential treatment or intensive outpatient therapy.

If you find it difficult to find appropriate coverage for your mental health needs, or the needs of a loved one, contact your county behavioral health department.

The federal Substance Abuse and Mental Health Services Administration also offers a service locater, samhsa.gov/treatment/index.aspx on its website.