Insurers should cover mental health and substance use disorder benefits in a manner no more restrictive than their coverage of medical and surgical benefits.
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. Application of MHPAEA was extended to the individual market by the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010.
- On November 8, 2013, the Departments of Treasury, Labor and Health and Human Services issued a final rule governing implementation for group and individual health plans.
- On March 29, 2016, the Centers for Medicare and Medicaid Services (CMS) issued a final rule applying MHPAEA to Medicaid managed care, CHIP and Alternative Benefit Plans.
- On October 27, 2016, the White House Mental Health and Substance Use Disorder Parity Task Force released its report, which highlights progress to date on parity implementation and offers recommendations to support consumers and improve parity implementation and enforcement.
October 10, 2018, by unanimous consent the Senate passed the resolution honoring the 10th anniversary of the enactment of the Mental Health Parity and Addiction Equity Act (MHPAEA). The resolution was sponsored by Sen. Klobuchar (D-MN) with Senators Cassidy (R-LA), Smith (D-MN), Roberts (R-KS), Murphy (D-CT), Carper (D-DE), Whitehouse (D-RI), Durbin (D-IL), Stabenow (D-MI), Menendez (D-NJ), Cardin (D-MD), and Collins (R-ME).
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.
ASAM's brief on mental health and addiction parity at the state level provides a background on the issue of parity, ASAM's parity policy positions, and a path forward for stakeholders interested in strengthening parity enforcement in their states.
Mental Health & Substance Use Disorder Essential Health Benefits
The Affordable Care Act (ACA) expanded MHPAEA’s protections. As a result, qualified health plans (individual and small group health plans offered in and outside the health insurance exchanges) and the benefits offered to the Medicaid expansion population must include MH/SUD benefits as an essential health benefit, and thereby, must comply with the parity law.
Short-term health plans (health insurance plans of a duration of less than 12 months, with possible extensions of up to 36 months) do not have to comply with MHPAEA.
“Enhanced Attestation”: A Simple Tool Regulators Can Use to Help Enforce the Mental Health Parity and Addiction Equity Act
The “Enhanced Attestation” form guides payers through the necessary analyses to demonstrate compliance with the law, which can then be made available to a state department of insurance upon request for its own regulatory review. An “enhanced attestation” form requires issuers to attest that they have performed analyses in each the categories of compliance covered by the federal parity law:
- Defining mental health and substance use disorder benefits and medical/surgical benefits
- Assigning benefits into classifications
- Financial requirements and quantitative treatment limitations (QTLs)
- Cumulative financial requirements and QTLs
- Nonquantitative treatment limitations (NQTLs)
- Disclosure requirements
- Vendor coordination
“Enhanced Attestation” can provide payers and regulators with a clearer picture for potential next steps. This could lead to market-conduct examinations and streamlined enforcement processes, as well as support improved communication between regulators and payers. But most of all, it may help ensure patients receive the coverage for mental and substance use disorders that they are due.
Read more about the "Enhanced Attestation" form here.
Access the "Enhanced Attestation" form here.
ASAM's Public Policy Statement on Third-Party Payment for Addiction Treatment covers a wide range of insurance issues, including the importance of insurers providing coverage for mental health and substance use disorder treatment at parity with those benefits covering general medical illnesses, with the same provisions, lifetime benefits, and catastrophic coverage.
The American Psychiatric Association developed model parity legislation specifically adapted for each state, amending the appropriate sections of state code or creating new sections in the right titles or chapters and includes appropriate terminology for each state.
This consumer guide, created by ParityTrack, shows which types of insurance are exempt from MHPAEA and what benefits may be subject to parity rules.
This public awareness campaign aims to create a consumer-driven movement to demand parity rights and save lives. The campaign provides fact sheet and insurance resources as well as information about parity rights.
The National Council on Behavioral Health's toolkit is designed to help health care providers and their staff handle claim denial appeals and prior authorizations.
The Kennedy Forum has created an extensive parity toolkit that provides resources for consumers handling parity violations, as well as social media messaging to advocate for change!
How to File a Complaint
If you believe a payer has violated parity rules, here is how to file a complaint:
- Identify your type of insurance coverage from the chart below
- Complete your complaint letter using the templates
- Submit to the responsible agency
Identify your type of insurance coverage
Insurance plans (plans purchased by employers, or by individuals)
Employer pays for coverage (Self-funded plan)
Insurance through state/local government employers
Submit to the responsible agency
State insurance commissioner. Find your commissioner.
U.S. Department of Labor
Employee Benefits Security Administration
U.S. Department of Health and Human Services
1-877-267-2323 x 61565
Thank you to the American Psychiatric Association for this chart.