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Mental Health and Substance Use Disorder Insurance Coverage and Model Legislation

APA has created parity-implementation legislation for all 50 states and the District of Columbia. The legislation is designed to require transparency and accountability from insurers and state regulators. Each state has legislation that is tailored specifically for that state's terminology and formatting.

Overview of Mental Health and Substance Use Disorder Parity

President George W. Bush signed the Mental Health Parity and Addiction Equity Act into law on October 3, 2008. The Act was sponsored by Congressman Patrick J. Kennedy (D-RI). Parity as a concept is very simple: insurance coverage for mental health and substance use disorder care should be no more restrictive than insurance coverage for any other medical condition. However, the Federal Parity Law is very complex, and implementation of the law can be challenging.

Insurers have done a very good job of coming into compliance with some of the more straightforward components of the law, such as making sure copays and visit limits for mental health and addiction care are no more restrictive than they are for other medical care. However, insurers are likely not complying with some of the more complicated components of the law, albeit unintentionally.

Many of these trouble spots relate to how insurers design and apply their managed care practices, such as prior authorization requirements, step therapy, and requirements for providers to join an insurer's network. Often, insurers design and apply these managed care techniques in ways that are more restrictive for mental health and substance use disorder treatment than for other medical treatment, which violates the Federal Parity Law and can lead to deaths from suicides, overdoses and other forms of preventable death.

States have primary enforcement authority over insurers that sell health insurance policies in their states. While there is growing interest by state insurance departments to implement the law and increasing willingness by insurers to submit data to regulators demonstrating compliance, there is much uncertainty about how to do so in an efficient manner that meets the tests of the law. This legislation provides a roadmap for how insurers and regulators can secure compliance without undue administrative burden.

  • First, the legislation establishes reporting requirements for insurers to demonstrate how they design and apply their managed care tactics, so regulators can determine if there is compliance with the law.
  • Second, the legislation specifies how state insurance departments can implement parity and then report on their activities.
  • And third, the legislation eliminates some managed care barriers to medication-assisted treatment for substance use disorders. While those provisions are not purely parity requirements, they can be a vital tool in combatting the opioid epidemic.

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State Model Parity Legislation Adapted to All 50 States and the District of Columbia

One of the American Psychiatric Association's major legislative goals is to achieve mental health parity and parity enforcement across the country. To that end, model parity legislation has been specifically adapted for each state, amending the appropriate sections of state code or creating new sections in the right titles or chapters. This model legislation also uses the correct terminology for MH/SUD used in each state, the correct terminology for health insurers, and the right terminology for the insurance commissioner. Additionally, each bill is formatted exactly as bills are drafted in that state.

There are four versions for each state: one comprehensive bill and then three smaller bills that are each of the components of the comprehensive bill (addressing insurer reporting requirements, addressing commissioner implementation requirements, or addressing MAT coverage provisions). This allows each state to address the needs within that state, such as pursuing an incremental strategy or the comprehensive model legislation. Please find the different versions for each state below.

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Comprehensive State Model Parity Legislation for Each State

This is the comprehensive version of the state model parity legislation, which includes provisions for insurer reporting requirements, commissioner implementation requirements, and addressing MAT coverage provisions.

Find your state's comprehensive model parity legislation

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Model Parity Legislation Addressing Insurer Reporting Requirements

This version of the model parity legislation is the section that only addresses insurer reporting requirements.

Find your state's model legislation addressing insurer reporting requirements

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Model Parity Legislation Addressing Commissioner Implementation Requirements

This version of the model parity legislation is the section that addresses commissioner implementation requirements only.

Find your state's model legislation addressing commissioner implementation requirements

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Model Parity Legislation Addressing MAT Coverage Provisions

This version of the model parity legislation is the section that only addresses MAT coverage provisions.

Find your state's model legislation addressing MAT coverage provisions

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Contact APA's Department of Government Relations Team

For more information on how your state can get involved in advancing mental health parity, please contact APA Director of Government Relations, Erin Berry Philp, at ephilp@psych.org, or your APA State Regional Director:

Tim Clement (Northeast – Region 1): tclement@psych.org
Amanda Chesley Blecha (Midwest – Region 2): achesley@psych.org
Marsi Thrash (South – Region 3): mthrash@psych.org
Tim Miller (West – Region 4): tmiller@psych.org

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