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.
2024 Mental Health Parity and Addiction Equity Regulations
On September 9, 2024, U.S. Departments of Labor, Health and Human Services, and Treasury released final mental health and addiction equity regulations that go a long way to help realize mental health parity and ensure health plans and payors are complying with federal parity law. The new regulations will ensure no material difference exists between covered health benefits, restrictive utilization management practices, and physician reimbursement rates for mental health and physical health services, among other things, effective January 1, 2025.
AACAP submitted formal comments in October 2023 on the proposed parity regulations. Read AACAP’s comments on the 2023 proposed parity regulation here and here.
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:
- 2024 Tri-agency Congressional Report on Mental Health Parity and Addiction Equity Act Enforcement and Implementation (Jan. 2025),
- American Medical Association: State Strategies to Improve Mental Health and Substance Use Disorder Parity
- Behavioral Health Parity-Pervasive Disparities in Access to In-Network Care Continue, RTI International (2024)
- A landmark report entitled Behavioral Health Parity-Pervasive Disparities in Access to In-Network Care Continue, shows continued disparities in the availability of in-network mental healthcare, and adequate reimbursement rates, compared to medical and surgical services. The report notes that patients are often forced to go out-of-network to receive behavioral health care, and that out-of-network use for these services was higher than for any medical/surgical specialty demonstrating the need for more robust mental health parity enforcement.
- 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:
- AACAP Responds to CMCS Request for Comments on Mental Health Parity Compliance in Medicaid/CHIP (December 4, 2023)
- AACAP Comments on Requirements Related to the Mental Health Parity and Addiction Equity Act (October 17, 2023)
- AACAP Comments on Parity Technical Release (October 17, 2023)
- CMS Fact Sheet: The Mental Health Parity and Addiction Equity Act
CMS provides a summary of key MHPAEA protections, regulations and guidance FAQ, and more.
- The Kennedy Forum's Parity Track
- Parity Implementation Coalition
- U.S. Department of Labor, Treasury, and Health and Human Services MHPAEA final regulations and guidance
- AACAP Comments on Strategies for Improving Parity for Mental Health and Substance Use Disorder Coverage (August 7, 2017)
- AACAP Comments on Interim Final Rules under the Paul Wellstone-Pete Domenici Mental Health Parity and Addiction Equity Act of 2008
(May 5, 2010)
- AACAP Comments on the Implementation of the Paul Wellstone-Pete Domenici Mental Health Parity and Addiction Equity Act of 2008
(May 28, 2009)
- AACAP Policy Statement: Parity and Access for Child and Adolescent Mental Health Care
- Medical Necessity Criteria
National Organizations Support Mental Health Parity