Mental Health Parity Resources
Mental Health Parity
What is it: The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA or Parity Law) is federal legislation addressing the issue of providing insurance coverage for mental illness and substance abuse access to services and care equal to the services provided for physical care and physical illnesses, especially for financial requirements and treatment limitations. The MHPAEA, originally applied to group health plans and group health insurance coverage, was amended by the Affordable Care Act (ACA) to also apply to individual health insurance coverage.
What does it do: To enact the Parity law, providers, consumers and others must push state insurance commissions to hold health insurance plans accountable for equal services of mental illnesses and substance abuse. There are effective evidence-based treatments for most mental illnesses, yet too many of those suffering don’t receive the mental health care they need. The lack of services and access to care is in part due to mental health care systems lack of providers. The lack of services is also due to health insurance plans that do not comply with the law for providing services in the commercial market, Medicaid managed care and the Children’s Health Insurance Program.
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 receive treatment. 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 control the expenses for mental health care and substance abuse treatment by reducing the number of providers whose services they cover (like not covering Psych APRN’s, reduce the number of services covered by increasing the number of Non-Qualified Treatment Limitations (Services not covered called NQTLs like impatient care) or not providing coverage for any mental health services.
What can nurses do: Become familiar with the rules of how insurance companies are authorized to do business through the state insurance commissions. There are accreditation services that review insurance companies’ rules and performance on mental health, that can help state insurance commissions to decide if an insurance company should do business in any give state. This includes checking the rate of coverage denials, rate of mental health\substance abuse NQTLs compared to medical illnesses, whether integrated behavioral care is covered and if a range of behavioral health providers, including nursing, 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: There are a series of links on this page that provide you with information from a variety of resources. Click on the links and review the topic you are interested in.
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.
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.
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 “Six-Step” Parity Compliance Guide for Non-Quantitative Treatment Limitation (NQTL) Requirements Kennedy Forum Issue Brief (September 2017)
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.