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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.  On November 8, 2013, the Departments of Treasury, Labor and Health and Human Services issued a final rule governing its implementation for group and individual health plans. 


  • On November 8, 2013, the Departments of Treasury, Labor and Health and Human Services issued a final rule governing its 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. A summary of the report and accompanying guidance is available here.
  • 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.

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 federal Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted in 2008 on a simple principle: Insurance coverage for mental health and addiction treatment should be no more restrictive than insurance coverage for other medical care. In other words, if a person has comprehensive insurance coverage for a chronic disease (such as hypertension), they should have a similar level of comprehensive coverage for mental health and substance use disorders. If it’s not as comprehensive—or if it’s more restrictive—that’s a parity violation.


How can state departments of insurance know if there’s a parity violation?


Parity implementation requires robust state oversight. The MHPAEA is complicated, and many insurance departments have learned that a thorough review is time consuming and frustrating—particularly when payers provide incomplete and or inconsistent information. One way that insurance departments can better monitor for parity violations is to require payers to demonstrate in advance that they are in compliance with the law.


Comparative analysis helps check payers’ parity compliance


The American Medical Association (AMA), American Society of Addiction Medicine (ASAM), and American Psychiatric Association (APA) believe that the obligation of demonstrating compliance with the law is something payers can and should do. Because the MHPAEA is a comparative law—payers should do the comparisons to analyze whether they are in compliance with the law. Requiring prior comparative analysis can help streamline oversight, can help payers identify gaps, and most important—may help ensure patients have the coverage required by the law.


“Enhanced attestation” can help provide streamlined comparative analysis


Fortunately, there is an “Enhanced Attestation” form that can help streamline oversight and, hopefully, increase MHPAEA compliance. The “Enhanced Attestation” 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.


Relevant ASAM Public Policy Statements

Managed Care, Addiction Medicine and Parity

Managed Care, Addiction Medicine and Parity: Supplement for Physicians and Others 

Learn more about how ASAM defines Utilization Review and recommendations on how and under what circumstances the process should be employed.
Health Gears

Parity in Publicly Funded Health Insurance Benefits for Addiction Treatment

Find out about ASAM's policy and recommendations to achieve parity in publicly financed health insurance plans and other systems of care.



Model State Parity Legislation

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.

Know Your Rights

This consumer guide, created by ParityTrack, shows which types of insurance are exempt from MHPAEA and what benefits may be subject to parity rules.

Don't Deny Me

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.

Warning Signs

Potential parity violations may not be obvious without comparisons with equivalent medical benefits. This guide issued by the Department of Labor 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

This guide, created by the Legal Action Center, 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.

Guide to Implementing and Enforcing MHPAEA Requirement for Addiction Prevention and Treatment Benefits

This guide, designed for state regulators, outlines some of the benefits that health plans should cover for addiction treatment and prevention.

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


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.


Additional Resources

Parity at 10 seeks to ensure that insurance carriers and state Medicaid programs comply with MHPAEA so consumers can access the evidence-based health care they need and are entitled by law to receive.