WASHINGTON -- New regulations requiring private group health insurance plans to offer benefits for treatment of substance abuse disorders that are comparable to benefits for other illnesses will help remove a barrier to treatment for millions of Americans, National Drug Control Policy (ONDCP) Director Gil Kerlikowske said today.
The rules, issued January 29th by the Departments of Health and Human Services, Labor, and Treasury, are expected to be finalized in the spring. They will take effect for plan years beginning on or after July 1, 2010. The rules prohibit group health insurance plans – typically offered by employers – from restricting access to care for mental health or substance use disorders by limiting benefits and requiring higher patient costs than those that apply to general medical or surgical benefits.
The rules begin to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. The law applies to employers with 50 or more workers whose group health plans offer mental health or substance use disorder benefits.
"These regulations build on the excellent work of the Congress and will make critically needed services available to the millions of Americans who are struggling with addiction," said Director Kerlikowske.
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Director Kerlikowske also said that the new law should help close the "treatment gap". In 2008, 23.1 million Americans age 12 and older met the diagnostic criteria for substance abuse problems or dependence. However, only 2.3 million received treatment at a specialty treatment center. One reason for the gap is that insurance coverage for such care is often minimal, said Kerlikowske.
Studies have shown that substance abusers incur higher medical costs than those who are receiving treatment for abuse. Major costs include emergency room visits and hospitalization. Families of untreated substance abusers also have higher medical costs than families of those who are getting treatment, according to a study. Other studies show that evidence-based treatments for substance dependence reduce medical costs significantly.
ONDCP Deputy Director A. Thomas McLellan commented that "the parity law and these regulations codify what we have long-known to be true: Addiction is a chronic illness that should be covered by insurance under the same terms as other chronic illnesses. This opens another pathway to recovery for countless Americans who have a drug or alcohol problem."
The interim final rules were developed based on the three departments’ review of public comments. Further comments are being solicited during a 90-day period following publication of the interim rules.