My Health Plan

Advocates for mental-health and substance-abuse patients have long lobbied for a "level insurance field," asking for the same kinds of coverage offered for physical ailments.

Rules issued yesterday by the Obama administration regarding the Mental Health Parity and Addiction Equity Act of 2008 take a major step toward achieving that goal.

The legislation -- passed with broad bipartisan support -- aims to remove financial barriers to treatment for people with mental-health and substance-abuse problems.

About 140 million Americans in more than 450,000 employer plans will benefit from improved coverage, according to the administration.

Included among the rules that will take effect July 1 are:

□ Health plans for employers with more than 50 workers cannot charge a higher co-pay or deductible for treatment for mental health or substance abuse than for a visit to the doctor or medical specialist. There also is no separate deductible.

□ The plans cannot set restrictions on the number of visits or hospital days for mental-health and substance-abuse problems that are different than those for medical problems.

□ The plans must offer out-of-network benefits for mental-health and substance-abuse treatments as they do medical and surgical treatments.

However, the act does not require that a group health plan provide benefits for mental health and substance abuse. It also does not apply to issuers who sell health-insurance policies to employers with 50 or fewer employees or who sell health-insurance policies to individuals.

Still, local and state mental-health officials and advocates applauded the approval.

"It is the right thing to do because health plans will now have to recognize mental illness as an illness," said Judy Briggs, the CEO of Carolina Behavioral Health Alliance and a local mental-health advocate.

For instance, Briggs said, previous standards limited the number of times a mentally-ill patient could see a doctor or therapist "regardless of how sick they were."

"You would never tell a diabetic you can only see your doctor 20 times a year even though your diabetes is totally out of control," Briggs said. "Both are biologically-based illnesses.

"But health plans enforced these limits on people with bipolar illness even if the illness was out of control."

Kathleen Sebelius, the U.S. secretary of health and human services, said that the rules "will, for the first time, help assure that those diagnosed with these debilitating and sometimes life-threatening disorders will not suffer needless or arbitrary limits on their care."

The N.C. Division of Mental-Health Services has been active in supporting legislation requiring parity in mental-health and substance-abuse treatment services, said Leza Wainwright, the director of the agency. "Since the rules just came out today, we have not had the opportunity to analyze them to begin to determine the impact upon North Carolina," she said.

Briggs cautioned that health plans, government agencies and advocates must "make sure that the care being provided is effective and efficient, and does not add unnecessary cost for health plans."