Advocacy

Parity

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) was passed in October, 2008 to end discriminatory health care practices against those with mental illness and/or addiction. The statute provides that plans cannot apply financial requirements or treatment limitations to mental health or substance use disorder (MH/SUD) benefits that are more restrictive than as applied to medical/surgical benefits. While the law has been implemented in commercial markets and a final rule has been released for Medicaid managed care plans, greater enforcement is needed for the law to have its intended effect. Use the resources below to advocate for full implementation of the MHPAEA.


How to File a Complaint

If you believe a payer has violated parity rules, here is how to file a complaint:

  1. Identify your type of insurance coverage from the chart below
  2. Complete your complaint letter using the templates
  3. Submit to the responsible agency

Step 1: Identify your type of insurance coverage from the list below Step 2: Complete your complaint letter using the templates Step 3: Submit to the responsible agency
Insurance plans (plans purchased by employers, or by individuals) Template complaint letter to state insurance commissioner State insurance commissioner. Find your commissioner.
Employer pays for coverage (Self-funded plan) Template complaint letter to Department of Labor

U.S. Department of Labor

Employee Benefits Security Administration

1-866-444-3272

Insurance through state/local government employers Template complaint letter to Department of Health and Human Services

U.S. Department of Health and Human Services

1-877-267-2323 x 61565

 

Thank you to the American Psychiatric Association for this chart.


Research and Reports

Many States are Ignoring ACA Requirements to Cover Addiction Treatment (CASA). This report finds that the benchmark plans used to define essential health benefits under the ACA offer inadequate addiction coverage.

Guide to Implementing and Enforcing MHPAEA Requirement for Addiction Prevention and Treatment Benefits (CASA). This guide, designed for state regulators, outlines some of the benefits that health plans should cover for addiction treatment and prevention.

Know Your Rights (ParityTrack). This consumer guide shows which types of insurance are exempt from MHPAEA and what benefits may be subject to parity rules.

Warning Signs (DOL). Potential parity violations may not be obvious without comparisons with equivalent medical benefits. This guide shows some of the utilization management techniques that could be violations if not applied to similar benefits across the health plan.

Health Insurance for Addiction and Mental Health Care: A Guide to the Federal Parity Law (LAC). This guide explains patients’ and providers’ rights to health insurance coverage for MH/SUD services under MHPAEA and touches on several other laws that impact patient and provider rights to insurance coverage for MH/SUD care.


Policy Resources

Public Policy Statement on Managed Care, Addiction Medicine and Parity: Supplement for Physicians and Others (ASAM)

Public Policy Statement on Parity in Publicly Funded Health Insurance Benefits for Addiction Treatment (ASAM)

Model State Parity Legislation (ParityTrack). ParityTrack has created a model state parity bill that individuals and organizations can use to advocate for and help facilitate the implementation and enforcement of MHPAEA. Each title of this model legislation targets critical areas that must be addressed by states to ensure that coverage of MH/SUD is equal to coverage of other medical conditions. This model bill includes a section requiring the use of the ASAM criteria for utilization review and benefit determination, as well as sections requiring coverage of FDA-approved medications for alcohol and opioid addiction and requiting insurers to use formulary determination policies for addiction medications that are no less favorable than the policies that govern formula placement for other medications.

Summary of Model State Parity Legislation (ParityTrack)

Information Sheet on Model State Parity Legislation (ParityTrack)