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The Paul Wellstone Mental Health and Addiction Equity Act mandates that group health plans provide mental health and substance-related disorder benefits that are at least equivalent to benefits offered for medical and surgical procedures. The legislation renews and expands provisions of the Mental Health Parity Act of 1996. While that bill requires only financial equity for annual and lifetime mental health benefits, this legislation also compels parity in treatment limits and expands all equity provisions to addiction services. Thus, the bill not only requires that the deductibles, co-payments, and out-of-pocket expenses applied to mental health and addiction services be no more stringent than those applied to medical and surgical services, but also mandates that limitations on frequency of visits, number of visits, and days of coverage for mental health be no more restrictive than those applied to medical and surgical services. All mental health and addiction disorders that are listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders would be subject to the act’s parity requirement. Additionally, if a health care provider offers out-of-network benefits for medical and surgical procedures, the provider must also make such benefits available for mental health and addiction disorders. The equity requirement applies only to group plans that cover 50 or more employees and includes a single-year exemption for plans that experience a high spike in premiums after implementation. The act does not preempt state laws that provide stronger mental health and addiction benefits protections.
The law also includes measures banning discrimination on the basis of genetic information by employers and insurers and provisions protecting the privacy of genetic data.
To download the full text of the regulations
Source: US Library of Congress
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