Mental Health Parity Resources
About Mental Health Parity
What is it? The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA or Parity Law) is federal legislation which ensures that insurance coverage and access to services and care for mental illness and substance use is equal to the services and care provided for physical illnesses, especially for financial requirements and treatment limitations. Previously restricted to group health plans and insurance coverage, it was amended to apply to individual coverage as well.
How is it effective? Enforcement of the Parity law relies on providers, consumers and others to keep state insurance commissions informed in order to hold health insurance plans accountable for covering services for mental illnesses and substance abuse equally with physical illnesses.
What makes this important? Mental illness costs the US nearly $200 billion each year, yet only 1 in 3 patients who are diagnosed with a serious mental illness receive treatment. This is partly due to a shortage of providers but also stems from health insurance plans that do not comply with the law. Outcomes for mental health care in real world settings lag far behind outcomes in large trials of evidence-based treatments.
Why should nurses be concerned? Many third-party insurance providers restrict the type of providers whose services they cover in order to control expenses for mental health care and substance use treatment. In addition, they reduce the number of services covered by increasing Non-Qualified Treatment Limitations (NQTLs.) Some do not offer coverage for any mental health services.
What can nurses do? Become familiar with the regulations in your state. Take a look at accreditation services who are reviewing the performance of insurance companies relating to mental health. Check the rate of coverage denials, the list of mental health and substance use NQTLs as compared to medical illnesses, whether integrated behavioral care is covered and if a range of behavioral health providers, including nurses, are included in reimbursement models. Volunteer to sit on any panel or board that is looking at these issues.
Where do I find out about Parity? Click on the links below to access resources about this important issue for nurses.
Final Rule Suit Statement
The final rule significantly expands access to STLDI plan (APNA is noted here) v Short-term health plans will limit mental health and substance use disorder coverage for at-risk populations and cause higher premiums for others.
Evaluating State Mental Health Statutes
Evaluating State Mental Health and Addiction Parity Statutes: A Technical Report. By comparing states' progress side by side we are able to determine where progress needs to be made.
President's Commission on Combating Drug Addiction and the Opioid Crisis
Recommendations of Congressman Patrick J. Kennedy to the President’s Commission on Combating Drug Addiction and the Opioid Crisis October, 2017.
States' Report Cards
Examining state track records a decade after MHPAEA is enacted. Deaths from drug and alcohol misuse and suicide are on a rapid rise, yet majority of states do not provide mental health parity – 32 states receive a failing grade.
The Pathway to Improving the Delivery of Mental Health Services in Education
The Kennedy Forum's 5 Pillars: The Pathway to Improving the Delivery of Mental Health Services in Education. With concerns over the increasing mental health needs of our youth ever present, a workable plan to meet the needs of children is paramount.
Model State Parity Legislation
The purpose of this model legislation is to facilitate implementation and enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA) and strengthen parity provisions within state law. Each section of this model legislation targets critical areas that must be addressed to ensure that coverage for mental health conditions and substance use disorders is equal to coverage for other medical conditions.
The Value and Values of Mental Health Policy
Mental Health America, July, 2016. A series of slides make the case for public mental health policy to overcome issues that impact large portions of the population.
The “Six-Step” Parity Compliance Guide for Non-Quantitative Treatment Limitation (NQTL) Requirements Kennedy Forum Issue Brief (September 2017) tools to determine if a plan or issuer is in compliance with the nonquantitative treatment limitation (NQTL) requirements specified in the final regulations of the MHPAEA.
Model Parity Legislation
The American Psychiatric Association has created parity-implementation legislation for all 50 states and DC. The legislation is designed to require transparency and accountability from insurers and state regulators.
FAQs about Parity and Buprenorphine Coverage
From the Department of Health and Human Services, these FAQs address parity in commercial plans under the Affordable Care Act as well as how parity applies to buprenorphine coverage.
Tools for Navigating the Health Insurance Marketplace
From the American Foundation for Suicide Prevention, information about the mental health and substance use disorder parity law and advice on how to select the health coverage that fits each consumer's needs.
Alternative Payment Models
Payment Reform and Opportunities for Behavioral Health: Alternative Payment Model Examples.