Officially implemented in 2010, the MHPAEA does not allow group health plans or insurance issuers to have lower-quality benefits for behavioral health treatment than for standard medical or surgical treatment. 4 The act does not force plans to cover mental health or SUD treatment but protects patients who already have this coverage in their plans. 4 If a health plan covers mental health and SUD treatment, the number of behavioral health visits, days of coverage, lifetime dollar limits, and out-of-pocket costs cannot be more exclusive than the medical benefits provided.4 Out-of-network mental health and SUD benefits must also be included if this is also part of the plan for medical benefits. 4 The act was meant to create equal coverage between behavioral and medical/surgical health services and improve access to mental health resources for more individuals.
Full Answer
What does the MHPAEA mean for mental health insurance?
Under the MHPAEA, mental health parity rules were expanded to include coverage for the treatment of substance use disorders. And the overall parity rules were expanded to include cost-sharing and treatment limits, as opposed to just an overall dollar cap on benefits.
What happens if a state is not enforcing MHPAEA?
In states that are not enforcing MHPAEA, CMS reviews health insurance policy forms of issuers in the individual and group markets for compliance with MHPAEA before the products are offered for sale.
Are there any exemptions from the MHPAEA?
Exemptions from MHPAEA. MHPAEA retains the exemption for small employers contained in MHPA. MHPAEA modified the exemption contained in MHPA based on increased cost in several respects, which are explained in the statute.
Does your self-insured plan violate MHPAEA?
EBSA’s Boston Regional Office determined that a self- insured plan violated MHPAEA by excluding coverage for out-of-network residential treatment for mental health and substance use disorders, which did not apply to medical/surgical benefits in the same classification.
What is the Mental Health Parity and Addictions Equity Act Mhpaea of 2008?
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those ...
Who benefits from Mhpaea?
The MHPAEA is beneficial for those who may need the most intensive treatment and financial protection. To comply with specific requirements of the law, therefore, health plans need to pay close attention to the benefits they offer. Protections under the MHPAEA include financial requirements and treatment limitations.
What plans are subject to Mhpaea?
MHPAEA applies to plans sponsored by private and public sector employers with more than 50 employees, including self-insured as well as fully insured arrangements. MHPAEA also applies to health insurance issuers who sell coverage to employers with more than 50 employees.
Does the Mhpaea influence the Affordable Care Act?
The Affordable Care Act builds on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA, or the federal parity law), which requires group health plans and insurers that offer mental health and substance use disorder benefits to provide coverage that is comparable to coverage ...
Does Mhpaea apply to Medicare?
Beyond that, MHPAEA applies to Medicare Advantage coverage offered through a group health plan, Medicaid managed care plans, the State Children's Health Insurance Program, and state and local government plans that do not opt-out.
How is Mhpaea enforced?
CMS has enforcement jurisdiction over MHPAEA in the individual and fully insured group markets in states where it has enforcement authority and over non-federal governmental group health plans, such as plans sponsored by state and local governments for their employees.
Why was Mhpaea enacted?
In 2008, Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) to ensure equal coverage of treatment for mental illness and addiction.
What are non quantitative treatment limitations?
What are Non-Quantitative Treatment Limitations (NQTL)? NQTLs are processes, strategies, evidentiary standards, or other criteria that limit the scope or duration of benefits for services provided under the plan.
What does mental health parity law require?
California's Mental Health Parity Act, as amended in 2020, requires all state-regulated commercial health plans and insurers to provide full coverage for the treatment of all mental health conditions and substance use disorders.
What does the Affordable Care Act say about mental health?
After the Affordable Care Act The ACA also guaranteed access to mental health services within individual, small-group (fully insured), and Medicaid expansion plans by mandating that they cover 10 essential health benefits, including mental health and prescription drugs.
When did mental health become covered by insurance?
The Mental Health Parity and Addiction Equity Act (federal parity law) was enacted in 2008 and requires insurance coverage for mental health conditions, including substance use disorders, to be no more restrictive than insurance coverage for other medical conditions.
What major challenges are still associated with mental health coverage?
Despite patient interest, access to mental healthcare is left wanting due to limited clinician availability and cultural stigma.Mental health clinician shortage.Limited mental health access parity.Fragmented mental and physical health access.Social stigma and limited mental health awareness.
What is MHPAEA medical necessity?
MHPAEA requires that plans make certain information available with respect to MH/SUD benefits. First, the criteria for medical necessity determinations with respect to MH/SUD benefits must be made available to any current or potential participant, beneficiary, or contracting provider upon request.
What is the MHPAEA?
Background. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits. MHPAEA, which amended the Public Health Service Act, the Employee Retirement Income Security Act (ERISA) and the Internal Revenue Code, generally is effective for plan years beginning on or after October 3, 2009. For calendar year plans, the effective date is January 1, 2010. The Departments of Health and Human Services (HHS), Labor (DOL), and the Treasury will publish in the Federal Register an interim final rule implementing the provisions of MHPAEA on February 2, 2010. The regulation is effective on April 5, 2010, and applicable to plan years beginning on or after July 1, 2010.
What is the MHPAEA final rule?
The MHPAEA interim final rule amends and modifies certain provisions in the MHPA regulations. Although MHPAEA provides significant new protections to participants in group health plans, it is important to note that MHPAEA does not mandate that a plan provide MH/SUD benefits. Rather, if a plan provides medical/surgical and MH/SUD benefits, ...
What is treatment limitation?
MHPAEA also provides similar protections for treatment limitations. “Treatment limitations” mean limits on the frequency of treatment, number of visits, days of coverage, or other similar limits on the scope or duration of treatment. The regulation clarifies that there may be both quantitative and nonquantitative treatment limitations, ...
How many classifications does the predominant/substantially all test apply to?
The regulations provide that the “predominant/substantially all” test applies to six classifications of benefits on a classification-by-classification basis. The regulation also includes other rules and definitions that are necessary in order for plans, issuers and their advisers to apply this general parity test.
Does MHPAEA apply to medical insurance?
Rather, if a plan provides medical/surgical and MH/SUD benefits, it must comply with the MHPAEA’s parity provisions. Also, MHPAEA does not apply to issuers who sell health insurance policies to employers with 50 or fewer employees or who sell health insurance policies to individuals. MHPAEA Continues and Expands MHPA.
Does HHS have enforcement authority?
While State insurance commissioners have primary authority over issuers in the large group market, HHS has secondary enforcement authority . MHPAEA supplements prior provisions under the Mental Health Parity Act of 1996 (MHPA), which required parity with respect to aggregate lifetime and annual dollar limits for mental health benefits.
What is the MHPAEA?
The Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law requiring group health care plans to offer mental health and/or substance abuse (MH/SUD) benefits on par with the medical and surgical benefits offered. This legislation does not require health plans to offer mental health and/or substance abuse (MH/SUD) benefits, but if such benefits are offered, they must be no less restrictive than the medical/surgical benefits in the plan.
Where can I find the MHPAEA?
Basic information about the implementation of the MHPAEA can be found on the Centers for Medicaid and Medicare Services (CMS) website . The basic premise of the law is fairly straightforward, but a number of required regulations may make implementation of the law somewhat more complicated.
Why was the MHPAEA created?
The MHPAEA was originally enacted to prevent health insurers from placing more treatment limitations (such as number of visits) or financial requirements (such as amount of co-pay) on services related to mental health and substance abuse. Prior to the MHPAEA, a health plan might offer an unlimited number of medically necessary appointments ...
When was the Mental Health Parity Act passed?
Before the MHPAEA of 2008 became law, there was the Mental Health Parity Act (MHPA) of 1996, which was introduced by legislators Pete Domenici and Paul Wellstone after decades of advocacy work to gain parity in health care. This legislation required all group health plans offering mental health care benefits and covering 50 or more employees ...
When was the Affordable Care Act passed?
MHPAEA and the Affordable Care Act. The Patient Protection and Affordable Care Act (PPACA), also known as Obamacare, was passed in 2010. This act expanded and extended the reach of the MHPAEA even further. The PPACA impacted the MHPAEA by:
What does MH/SUD mean?
If a group health plan includes both MH/SUD and medical/surgical benefits, the MH/SUD benefits “must be no more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits.”. This simply means the same financial requirements and treatment limitations of more than half ...
Does MHPAEA apply to small businesses?
MHPAEA does not apply to small businesses who employ fewer than 51 employees. Additionally, MHPAEA’s requirements do not apply to plans offered to state and local government employees, when certain administrative steps are taken (such as sending notice to enrollees).
What is the MHPAEA?
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.
When is MHPAEA effective?
A final regulation implementing MHPAEA was published in the Federal Register on November 13, 2013. The regulation is effective January 13, 2014 and generally applies to plan years (in the individual market, policy years) beginning on or after July 1, 2014. See http://www.gpo.gov/fdsys/pkg/FR-2013-11-13/pdf/2013-27086.pdf for the full text of the final regulation. This followed an interim final regulation, which was published in the Federal Register on February 2, 2010 and generally applies to plan years beginning on or after July 1, 2010. See http://edocket.access.gpo.gov/2010/pdf/2010-2167.pdf - Opens in a new window for the full text of the regulation.
History of Mental Health Parity
The first mental health parity rules took effect in 1998, under the Mental Health Parity Act (MHPA). This law, signed by President Bill Clinton in 1996, prohibited large-group (employer-sponsored) health plans from having lower dollar caps (the maximum they would pay) for mental health benefits than they had for medical or surgical benefits.
Mental Health Parity and the Affordable Care Act
Under the MHPA and MHPAEA, group health insurance plans were not required to cover mental health care, and mental health parity rules did not apply to small-group plans or individual/family plans.
Ongoing Gaps in Mental Health Coverage
The MHPA, MHPAEA, and ACA have made substantial improvements in terms of access to mental health coverage. But there are still people who struggle to access mental health and substance use treatment, even on plans that are regulated under mental health parity laws .
Summary
For more than a quarter of a century, various mental health parity rules have applied to at least some health plans in the United States. And over time, these provisions have increasingly targeted some of the worst gaps in coverage that previously prevented people from obtaining mental health and substance use treatment.
A Word From Verywell
If you have health coverage in the United States, you likely have coverage for mental health and substance use treatment. And although coverage specifics vary greatly from one plan to another, various rules have been put in place over the last couple of decades to ensure that mental health benefits are covered the same as medical/surgical benefits.
When was the Mental Health Parity and Addiction Equity Act passed?
In 2008, Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) requiring comprehensive standards for equitable coverage of mental health and substance use disorder treatment and coverage of medical/surgical treatment.
How many people have mental health issues?
About one in five adults in the U.S. has a mental health condition, and nearly 20 million people aged 12 and older have a substance use disorder. NAMI successfully fought for passage of a federal parity law in 2008 called the Mental Health Parity and Addiction Equity Act that was intended to improve coverage for mental health ...
What is mental health parity?
Parity is the basic idea that mental health and addiction care are covered at the same level as care for other health conditions. State and federal laws have attempted to address discriminatory practices in health insurance by creating requirements around parity. In 1996, the Mental Health Parity Act ...
What is NAMI insurance?
NAMI supports establishment and enforcement of laws and policies that ensure parity between mental health and physical health services in all forms of insurance coverage.
Why is mental health parity so complex?
Enforcing mental health parity is complex partly because a patchwork of federal and state entities are responsible for enforcement and the onus is largely on consumers to file individual claims of discrimination. NAMI strongly supports efforts to address these issues and achieve mental health parity in all forms of health coverage.
Is parity achieved in mental health?
Despite these laws, the promise of true parity has not been achieved, and many people with mental illness are still being denied the care that they need and deserve. People with mental health conditions struggle to find a mental health care provider in network or getting treatment approved by their health plan.
Does insurance cover mental health?
As such, it is critical for health insurance to provide comprehensive coverage of mental health and substance use disorder services. Yet, too often, health insurance covers mental health care differently than other kinds of medical services, creating barriers to affordable, accessible mental health care and reinforcing a stigma around mental ...
Contents
Introduction
- The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. MHPAEA …
Key Changes Made by MHPAEA
- Key changes made by MHPAEA, which is generally effective for plan years beginning after October 3, 2009, include the following: 1. If a group health plan or health insurance coverage includes medical/surgical benefits and MH/SUD benefits, the financial requirements (e.g., deductibles and co-payments) and treatment limitations (e.g., number of visits or days of covera…
Exceptions
- There are certain exceptions to the MHPAEA requirements. Except as noted below, MHPAEA requirements do not apply to: 1. Self-insured non-Federal governmental plans that have 50 or fewer employees; 2. Self-insured small private employers that have 50 or fewer employees; 3. Group health plans and health insurance issuers that are exempt from MHPAEA based on their i…
MHPAEA Regulation
- A final regulation implementing MHPAEA was published in the Federal Register on November 13, 2013. The regulation is effective January 13, 2014 and generally applies to plan years (in the individual market, policy years) beginning on or after July 1, 2014. See http://www.gpo.gov/fdsys/pkg/FR-2013-11-13/pdf/2013-27086.pdf for the full text of the final re…
Contents
Introduction
- The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. MHPAEA …
Summary of MHPAEA Protections
- The Mental Health Parity Act of 1996 (MHPA) provided that large group health plans cannot impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical/surgical benefits. MHPAEA preserves the MHPA protections and adds significant new protections, such as extending the parity requir...
Key Changes Made by MHPAEA
- Key changes made by MHPAEA, which is generally effective for plan years beginning after October 3, 2009, include the following: 1. If a group health plan or health insurance coverage includes medical/surgical benefits and MH/SUD benefits, the financial requirements (e.g., deductibles and co-payments) and treatment limitations (e.g., number of visits or days of covera…
Exceptions
- There are certain exceptions to the MHPAEA requirements. Except as noted below, MHPAEA requirements do not apply to: 1. Self-insured non-Federal governmental plans that have 50 or fewer employees; 2. Self-insured small private employers that have 50 or fewer employees; 3. Group health plans and health insurance issuers that are exempt from MHPAEA based on their i…
MHPAEA Regulation
- A final regulation implementing MHPAEA was published in the Federal Register on November 13, 2013. The regulation is effective January 13, 2014 and generally applies to plan years (in the individual market, policy years) beginning on or after July 1, 2014. See http://www.gpo.gov/fdsys/pkg/FR-2013-11-13/pdf/2013-27086.pdf for the full text of the final re…
History of Mental Health Parity
- The first mental health parity rules took effect in 1998, under the Mental Health Parity Act (MHPA). This law, signed by President Bill Clinton in 1996, prohibited large-group (employer-sponsored) health plans from having lower dollar caps (the maximum they would pay) for mental health benefits than they had for medical or surgical benefits. But the MHPA did not require cov…
Mental Health Parity and The Affordable Care Act
- Under the MHPA and MHPAEA, group health insurance plans were not required to cover mental health care, and mental health parity rules did not apply to small-group plans or individual/family plans. But the Affordable Care Act(ACA) made some significant improvements in terms of ensuring access to mental health and substance use care. It was signed in...
Ongoing Gaps in Mental Health Coverage
- The MHPA, MHPAEA, and ACA have made substantial improvements in terms of access to mental health coverage. But there are still people who struggle to access mental health and substance use treatment, even on plans that are regulated under mental health parity laws. Large-group health plans and self-insured health plansare not required to cover the ACA’s essential he…
Summary
- For more than a quarter of a century, various mental health parity rules have applied to at least some health plans in the United States. And over time, these provisions have increasingly targeted some of the worst gaps in coverage that previously prevented people from obtaining mental health and substance use treatment. The Mental Health Parity Act took effect in the late 1990s …
A Word from Verywell
- If you have health coverage in the United States, you likely have coverage for mental health and substance use treatment. And although coverage specifics vary greatly from one plan to another, various rules have been put in place over the last couple of decades to ensure that mental health benefits are covered the same as medical/surgical benefits. If you feel that mental health parity …