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.
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
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
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