Policy Statement on Mental Health and Substance Use Parity
The American Academy of Child and Adolescent Psychiatry (AACAP) is committed to eliminating barriers to accessing behavioral healthcare for children. Despite dramatic advances in scientific knowledge regarding pediatric mental illness and treatment, only half (53.5%) of children receive needed care. Because mental health is a vital part of overall health, AACAP supports federal and state parity laws that facilitate patients and families in accessing the full range of appropriate behavioral health evaluation and treatment services. Treatment must be accessible without discriminatory financial penalties, hardship, or stigma, regardless of the source of insurance.
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires that the financial requirements (such as deductibles, copayments, or coinsurance) and treatment limitations imposed on mental health and substance use disorder benefits not be more restrictive than those applied to medical and surgical benefits. Despite a federal requirement that plans and issuers provide comparative analyses of their non-quantitative treatment limitations, none of the required comparative analyses had sufficient data to demonstrate compliance with parity regulations by health instance/payers.
To ensure that health plans comply with state and federal mental health and substance use parity laws, AACAP recommends that:
- State and Federal agencies that regulate health plans enforce mental health and substance use parity laws to the fullest extent of their authority.
- State and federal agencies that regulate health plans mandate health plan comparative analyses of how plans apply non-quantitative treatment limitations to mental health and substance use benefits as compared to medical/surgical benefits and comparative analyses of health plan reimbursement for behavioral health services as compared to medical/surgical services.
- Entities not covered by federal parity requirements (e.g., small private employers that are self-insured, retiree-only plans) should be encouraged, in the best interests of children and their families, to adopt the same parity requirements as required by federal parity law.
- State and federal health plan regulators educate consumers, including parents, caregivers, and youth, on their rights regarding behavioral healthcare insurance coverage, including the benefits they are entitled to, health plan requirements per parity legislation and how to appeal parity violations.
- Medical necessity determinations are based on generally accepted standards of care as developed by national professional medical associations.