Insurers should cover mental health and substance use disorder benefits in a manner no more restrictive than their coverage of medical and surgical benefits.
Mental Health/Substance Use Disorder Parity
Legislative and Regulatory History
The Mental Health Parity Act (MHPA) of 1996 required parity in annual and lifetime limits for mental health benefits for large employer plans (fully and self-insured) that covered MH and medical/surgical (M/S) benefits. MHPA provided exemptions for small-employer plans (fully and self-insured) that faced increased costs due to implementation.
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) was passed in October, 2008 and expanded the scope of parity requirements to include substance use disorder (SUD). The statute also provided that plans cannot apply financial requirements or treatment limitations to MH/SUD benefits that are more restrictive than as applied to M/S 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 of parity requirements 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.
In 2021, Congress passed the Consolidated Appropriations Act that included requirements for plans to perform and document comparative analyses of their nonquantitative treatment limitations (NQTLs) for MH/SUD and M/S benefits. Congress subsequently passed the the Consolidated Appropriations Act (2023) that removed the ability of self-insured, nonfederal governmental plans to opt out of MH/SUD parity requirements and provided funding to states to enforce parity requirements.
On September 9, 2024, the Departments of Labor, Health and Human Services, and Treasury issued a final rule that implemented amendments made by the Consolidated Appropriations Acts of 2021 and 2023. An analysis from The Kennedy Forum is linked here.
ASAM's Public Policy Statement on Third-Party Payment for Addiction Treatment
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.
Resources
Departments of Labor, Health and Human Services, Treasury Issue Final Rules Strengthening Access to Mental Health, Substance Use Disorder Benefits
On September 9, 2024, the final rule implementing changes to federal parity requirements was released. An analysis of the rule from the The Kennedy Forum can be found here. Additional information can be found at the following links below.
- HHS Press Statement
- MHPAEA Final Rule
- DOL Press Release
- DOL Fact Sheet
- White House Fact Sheet
- Medicaid Parity and CHIP Tools
- New Mental Health and Substance Use Disorder Parity Rules: What They Mean for Participants and Beneficiaries
- New Mental Health and Substance Use Disorder Parity Rules: What They Mean for Providers
- New Mental Health and Substance Use Disorder Parity Rules: What They Mean for Plans and Issuers
Congressional Research Service (CRS) Parity Report
This 2023 CRS report provides an understanding of private coverage of mental health and substance use disorder (MH/SUD) benefits, including diagnostic and treatment services. It also explains federal requirements related to coverage of MH/SUD benefits, as well as federal MH parity requirements, with respect to private health insurance.
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.
A Review of State Efforts to Enforce
Mental Health Parity: Lessons for Policymakers and Regulators
On October 13, 2022, The Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute released a report highlighting the extensive barriers that states face to oversee and properly enforce Mental Health Parity and Addiction Equity Act (MHPAEA).
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.
The National Council on Behavioral Health's Toolkit
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's Parity Toolkit
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
Step 1
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
Step 2
Complete your complaint letter
Template complaint letter to state insurance commissioner
Download Template
Template complaint
letter to Department of Labor
Download Template
Template complaint letter to Department
of Health and Human Services
Download Template
Step 3
Submit to the responsible agency
State insurance commissioner. Find your commissioner.
U.S. Department of Labor
Employee Benefits Security Administration
1-866-444-3272
U.S. Department of Health and Human Services
1-877-267-2323 x 61565
Thank you to the American Psychiatric Association for this chart.