Mental Health Parity
The landmark Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), signed into law by President George W. Bush, sought to end health insurance discrimination between mental health and substance use disorder benefits and any physical health benefits.
The law does not require a health plan to offer mental health/substance use disorder benefits, but when they are offered, they must be on par with, or no more restrictive than, any physician/surgical plan benefits as they relate to financial requirements and treatment limitations.
What we now know is that health insurers are likely not complying with the full intent of the law, intentional or not, and state lawmakers and regulators are increasingly interested in ensuring compliance with parity. Complying with parity is complicated and stringent oversight and enforcement is needed.
AACAP is actively involved efforts to advocate for more expansive parity through state and federal legislation.
Model State Parity Legislation
The American Psychiatric Association created parity-implementation legislation for all states and Washington, DC aimed at improving the transparency and accountability of insurers’ coverage of mental health and substance use benefits.
Research Reports:
- 2023 MHPAEA Comparative Analysis Report to Congress (July)
- FY 2022 MHPAEA Enforcement Fact Sheet
The Employee Benefits Security Administration (EBSA) and the Centers for Medicare & Medicaid Services (CMS) are responsible for enforcing MHPAEA, together with the states. This enforcement fact sheet summarizes EBSA's and CMS's closed investigations and public inquiries related to MHPAEA during fiscal year (FY) 2022 to better inform the public of EBSA's and CMS's enforcement of MHPAEA.
- 2022 MHPAEA Report to Congress - Realizing Parity, Reducing Stigma, and Raising Awareness: Increasing Access to Mental Health and Substance Use Disorder Coverage (2022)
- The U.S. Departments of Labor, Health and Human Services, and Treasury (agencies) released a report to Congress, now required annually, on their effort to enforce the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (federal parity act). The findings signal that payers and plan administrators are failing to cover needed mental health and substance use disorder care by creating barriers to in-network mental health care, limited provider networks, and establishing non-qualitative treatment limits (NQTLs), not otherwise seen in medical and surgical benefits.
- Milliman Research Report - Addiction and mental health vs. physical health: Widening disparities in network use and provider reimbursement (2019)
- Milliman Research Report Addiction and mental health vs. physical health: Analyzing disparities in network use and provider reimbursement rates (2017)
- Milliman White Paper: Nonquantitative treatment limitations in the spotlight (2017)
Resources:
National Organizations Support Mental Health Parity