parity, mental health parity

Mental Health Parity

“Parity Poster” Helps Patients Report Unfair Insurance Practices 
 Parity poster image      

     
          

Federal law is clear that insurers can no longer discriminate against patients with mental illness, including substance use. But how many people know what constitutes a violation under the Mental Health Parity and Addiction Equity Act (MHPAEA)? Patients who know their rights are better equipped to protect their rights.

That’s why the American Psychiatric Association has created a new tool to help enforce the parity law and end discrimination: a poster titled, “Fair Insurance Coverage: It’s the Law.” Download the poster.

The poster clearly and simply explains the law and the steps to take when a violation is suspected. Print it out and post it (in physicians’ offices, clinics, break rooms at workplaces) and share the link. Also, look for the poster in the December 5 print edition of Psychiatric News.

 
     

Equal access to mental health coverage is the law.

Please join us in working to end discrimination against people seeking care for mental health conditions and substance use disorders.

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires that if a group health plan offers coverage for mental health or substance use disorder benefits, the financial requirements and treatment limitations for those benefits can be no more restrictive than the predominant requirements and limitations applied to substantially all medical/surgical benefits. This applies to private and public sector employers with more than 50 employees, including self-insured as well as fully insured plans.

MHPAEA permits self-insured state and local government employee plans to actively opt out of MHPAEA’s requirements for a specific plan year with option for renewal.  In addition to the small employer exemption, MHPAEA does not apply to individual market health coverage, retiree-only plans, Medicare, and certain other grandfathered plans.

What MHPAEA requires

The law requires that any group health plan that covers more than 50 employees and offers mental health and/or substance use disorders coverage must provide that coverage with no greater financial requirements (i.e., co-pays, deductibles, annual or life-time dollar limits) or treatment limitations (i.e., number of visits) than the predominant requirements the plan applies to substantially all medical / surgical benefits. 

Note that MHPAEA does not require employers to offer mental health or substance use disorder benefits, only that if they are offered they must be offered on par with medical/surgical benefits.

Under the Affordable Care Act, new individual and small group plans in and outside of the mandated health insurance exchanges are required to offer mental and substance use disorder coverage at parity.

Health plan implementation

The Parity Act became effective on October 3, 2009, and for most calendar-year plans began January 1, 2010.  Nevertheless, federal regulations that explain how parity is to be implemented had not been published by the time group health plans were required to have their new benefits in place.  Without federal guidance plans had to interpret what it means, under the law, to provide mental health and substance use disorder benefits that are no more restrictive than those applied to substantially all medical and surgical benefits they offer.

MHPAEA supplements the pre-existing Mental Health Parity Law (MHPA) of 1996 and MHPAEA’s interim final rule further amends certain provisions in MHPA. For example, plans are only permitted to manage the mental health and substance use benefit so long as they do not do so in a discriminatory manner.

For additional information on parity implementation visit the Parity Implementation Coalition (PIC) website ParityIsPersonal.  The APA is a founding member of the Coalition which was formed to help ensure that the MHPAEA is properly enforced.

APA Member note on reporting problems to the APA:

  • To report problems with parity or for other practice management issues members may call the HSF HelpLine at 800.343.4671 or send an email to hsf@psych.org.  Please include

    • a brief statement of problem,
    • your name and contact information (email/phone),
    • health plan's name,
    • type of health plan (e.g., group health plan, self-funded health plan, etc.),
    • state where insurance is issued,
    • whether company employs 50 or fewer employees        

(For questions about regulatory guidance contact the Department of Government Relations at 703.907.7800 or at advocacy@psych.org.) 

Reporting Problems to PIC (nonMembers):

  • Send an email to info@mentalhealthparitywatch.org or call 866.882.6227 to leave a voice mail message. Information provided to us will be held confidential. Please include
    • a brief statement of problem,
    • your name and contact information (email/phone),
    • health plan's name,
    • type of health plan (e.g., group health plan, self-funded health plan, etc.),
    • state where insurance is issued,
    • whether company employs 50 or fewer employees.

Resources

The following resources were written prior to the release of the Final Rules: