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Parity Policy and Implementation

For too long, many Americans paid for insurance coverage that did not recognize that mental health and substance use disorders are every bit as important as physical health, and that going without effective treatment can be debilitating and even life threatening.

One of the many important promises of both the Affordable Care Act and the Mental Health Parity and Addiction Equity Act is to ensure that health plans and insurers offer mental health and substance use disorder benefits that are comparable to their coverage for general medical and surgical care. Read more about measuring progress on mental health and substance use disorder parity.

But, parity is only meaningful if health plans are implementing it well, consumers and providers understand how it works, and there is appropriate oversight.

About the Mental Health Parity and Addiction Equity Act

The Know Your Rights: Parity for Mental Health and Substance Use Disorder Benefits brochure lists some of the common limits placed on mental health and substance use disorder benefits and services and includes additional information on parity.

The Center for Consumer Information and Insurance Oversight summarizes the Mental Health Parity and Addiction Equity Act (MHPAEA) and highlights the key changes from previous policy. The Center for Medicaid and CHIP Services summarizes the parity requirements for Medicaid and CHIP programs.

The Department of Labor parity page explains regulations and guidance for MHPAEA.

The Substance Abuse and Mental Health Services Administration offers an easy-to-understand consumer guide summarizing the MHPAEA language, and also recently released a white paper highlighting best practices of parity implementation and enforcement at the state level.

The White House Fact Sheet on Parity highlights how the Affordable Care Act and other policy actions have expanded the resources and protections for people that are affected by mental disorders.

Research on Parity Implementation

The Office of the Assistant Secretary for Planning and Evaluation issued two reports on early implementation of MHPAEA:

Timeline of Federal Parity Policies

Year

Event

1961

President Kennedy directs the Civil Service Commission (now known as the Office of Personnel Management) to implement parity (by 1975 this was scaled back)

1970s through present day

Parity laws enacted in many states – mostly for small group health plans; some for individual policies; many states establish minimum benefit level requirements for mental health and substance use disorders – employer-sponsored group health plans are generally exempt

1992

The first federal parity legislation is introduced in Congress by Senators Pete Domenici and John Danforth (S.2696)

1996

The Mental Health Parity Act enacted requiring comparable annual and lifetime dollar limits on mental health and medical coverage in large group health plans including employer-sponsored group health plans

1999

President Clinton directs the Office of Personnel Management to implement parity in the Federal Employee Health Benefit Plan (FEHBP)

2003

President Bush’s New Freedom Commission on Mental Health includes a recommendation regarding parity in the Commission’s Final Report

2008

Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) is signed into law – applying to large group health plans including employer-sponsored plans, effective for most plans starting in 2010

Medicare Improvements for Patients and Providers Act enacted including a provision to phase out statutory provision requiring a higher co-pay for outpatient mental health services

2009

Children’s Health Insurance Program Reauthorization Act enacted requiring parity in CHIP plans

CMS releases State Health Official letter to provide additional guidance regarding MHPAEA’s application to CHIP.

2010

The Affordable Care Act (ACA) enacted and extends parity protections to individual health insurance policies and Medicaid expansions to low-income childless adults

2010

Interim final rules issued to implement MHPAEA effective for most policies and plans in 2011

2013

Final rules are issued to implement MHPAEA – effective for most policies and plans in 2015

Final rules on Essential Health Benefits are issued, implementing mental health and substance use disorder as a category of EHB and extending MHPAEA final rule parity requirements to small group insurance and individual insurance plans starting in 2015

Final rules on Alternative Benefit Plans are issues providing further guidance regarding MHPAEA’s application to Essential Health Benefits in this Medicaid program.

Medicaid State Health Officials letter published providing guidance on the application of MHPAEA requirements to Medicaid managed care organizations, Medicaid Alternative Benefit Plans, and the Children’s Health Insurance Program

2016

TRICARE issues a proposed rule that levels cost sharing between medical-surgical and behavioral health care and eliminates treatment limits for mental health and substance use disorder care

2016

Final regulations issued on parity in Medicaid managed care organizations, Medicaid Alternative Benefit Plans, and the Children’s Health Insurance Program

 

Content created by Assistant Secretary for Public Affairs (ASPA)
Content last reviewed on June 21, 2016