Mental Health and Substance Abuse Equity Act
The law says that group health plans offering mental health or substance abuse benefits cannot place more restrictions on those benefits than on medical/surgical benefits under the plan.
The law was effective for the first plan year beginning on or after October 3, 2009 (January 1, 2010 for calendar year plans). However, federal agencies issued regulations implementing the law on February 2, 2010, which are effective on the first plan year beginning on or after July 1, 2010. (In both cases, there is a delay in the effective date for certain union plans.)
What group health plans must comply?
- Any insured or self-insured plan that offers mental health or substance abuse benefits must comply.
- There’s an exception for small plans—50 or fewer employees—but state parity laws will continue to apply.
- There’s an annual exemption where costs increase (1% or 2%, depending on plan year), but you must comply for six months and apply for exemption for the following year.
- There’s an exception for most on-site clinics, and hospital indemnity and specified-disease insurance policies.
What do health plans need to do?
- Review plan to determine if any coverage changes are needed (coordination of multiple options).
- Amend plan/policies as necessary.
- Modify plan notices as needed.
- Disclose required information upon request.