Mental Health Parity and Addiction Equity Act (MHPAEA)

October 25, 2016
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Millions of Americans with mental health or substance use disorders, including individuals participating in the Medicaid program do not have adequate insurance protection against the costs of treatment for mental and substance use disorders. The Mental Health Parity and Addiction Equity Act (MHPAEA) makes it easier for those Americans to get the care they need by prohibiting certain discriminatory practices that limit insurance coverage for behavioral health treatment and services. MHPAEA requires many insurance plans that cover mental health or substance use disorders to offer coverage for those services that is no more restrictive than the coverage for medical/surgical conditions. This requirement applies to:

  • Copays, coinsurance, and out-of-pocket maximums
  • Limitations on services utilization, such as limits on the number of inpatient days or outpatient visits that are covered
  • The use of care management tools
  • Coverage for out-of-network providers
  • Criteria for medical necessity determinations

In 2013, HHS’ Centers for Medicare and Medicare Services (CMS), released a State Health Official (SHO)  Letter that provided guidance to States regarding the implementation of  requirements under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA, Pub.L. 110-343) to Medicaid non-managed care benchmark and benchmark-equivalent plans (referred to in this letter as ABPs) as described in section 1937 of the Social Security Act (the Act), the Children’s Health Insurance Programs (CHIP) under title XXI of the Act, and Medicaid managed care organizations (MCOs) as described in section 1903(m) of the Act. The Centers for Medicare & Medicaid Services (CMS) previously issued a SHO letter on November 4, 2009, concerning section 502 of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA, Pub.L. 111-3).

On March 29, 2016 CMS put on display at the Federal Register a final rule applying MHPAEA to Medicaid and the Children’s Health Insurance Program (CHIP.)

Below are resources that may assist Medicaid Directors to understand MHPAEA’s application to the Medicaid program.

  1. Mental Health Parity Self-Assessment Tool
  2. Strategies for State Oversight of Implementation of the Mental Health Parity and Addiction Equity Act in Alternative Benefit Plans
  3. Alternative Benefit Plans
  4. Interim final regulations for implementing the federal mental health parity law of 2008
  5. U.S. Department of Labor Fact Sheet on MHPAEA
  6. U.S. Department of Labor Federal Parity Law Frequently Asked Questions (FAQs)

Source: Medicaid

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