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9:54 AM / Tuesday February 25, 2020

7 Feb 2020

Wolf administration proposes regulations to support mental health and substance use disorder coverage

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February 7, 2020 Category: Stateside Posted by:

Gov. Tom Wolf announced last Monday  that the Pennsylvania Insurance Department is introducing new regulations to protect consumers’ mental health and substance use disorder rights in the commonwealth. The regulations build on the department’s efforts to enforce equal standards of coverage between physical and mental health and substance use services.

“Accessing mental health services and treatment has been an ongoing concern reported through multiple task forces of my administration, including the School Safety Task Force, the Ready to Start Task Force, and the Suicide Prevention Task Force,” Wolf said. “When patients experience higher costs or fewer visits for mental health services than for other kinds of health care, there may be a parity violation causing these barriers to treatment. We are going to change that.”

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The new regulations will require health insurers that want to offer coverage in Pennsylvania to verify the company has completed documented analyses of its efforts to provide mental health and substance use coverage that is comparable to physical services in treatment limits, cost sharing, and in- and out-of-network coverage.

In addition to the verified analysis, insurers must make that documentation available to the department, upon request, to demonstrate compliance with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Documentation must also be available to policyholders and providers upon request.

“The Affordable Care Act and the Mental Health Parity and Addiction Equity Act guarantee that health plans and insurers offer mental health and substance use disorder benefits that are comparable to their coverage for general medical and surgical care,” said insurance commissioner Jessica Altman. “However, the objective of parity can only be fully realized if health plans are implementing it correctly, consumers and providers understand it, and there is proper oversight.”

The recently submitted regulations are one element of Gov. Wolf’s multi-agency effort and anti-stigma campaign, “Reach Out PA: Your Mental Health Matters.” The campaign is dedicated to expanding resources and the state’s comprehensive support of mental health and related health care priorities in Pennsylvania. The governor announced several initiatives and reviews the administration will undertake for commonwealth agencies to bolster the effort.

“A critical part of accessing mental health services is ensuring that state and federal parity laws are being followed by all insurance providers operating within the commonwealth,” Wolf said. “The recently submitted regulations give Pennsylvania insurers a clear understanding of what the Insurance Department will look for regarding parity. This type of transparency will allow those struggling with mental health or substance use disorders continued access to the care they need.”

Consumers with questions or concerns about their insurance plan’s compliance with parity laws can contact the Insurance Department’s Consumer Hotline at 1-877-881-6388.

As part of Reach Out PA, the governor introduced an online form for Pennsylvanians to provide feedback on mental health barriers, services and ways the commonwealth can better support mental health needs.

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