New Resources to Improve Parity Implementation in Your State
- Tips for Improving Access to Mental Health and Addiction Care by Improving State Medicaid Contracts outlines some contractual language that State Medicaid Directors should consider adding to managed care contracts. The suggested language would streamline the appeals process and clarify plan disclosure requirements.
- Tips for Providers on Negotiating Managed Care Contracts to Improve Access to Mental Health and Addiction Care is targeted to providers and outlines language that providers should consider negotiating into their managed care contracts. The suggested language would enable providers to represent their clients in a streamlined appeals process.
- Model parity legislation developed with national partners, led by Parity Track, can be used to introduce a bill in your state to address potential gaps in your current parity statute. It is comprehensive, but you can use all, or parts, depending on the needs of your state. The model legislation fact-sheet can be used to gain legislative support for a bill. It can also be modified to the specific needs and political climate of your state. If you are interested in pursuing parity legislation in your state, contact us so we can connect you to other organizations in your state who may be working on this issue.
Mental Health and Addictions Parity
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires health plans to offer mental health and/or substance use benefits without imposing copayments, benefit limitations and other restrictions that are more stringent than those imposed on medical/surgical benefits. Parity was also included as a central component of the Affordable Care Act (ACA). The ACA extended parity protections to the small-group and individual market, Medicaid expansion plans and plans sold through states’ health insurance marketplaces.
Between MHPAEA and the ACA, now nearly all health plans must cover behavioral health services at parity with medical/surgical treatment. Final regulations pertaining to parity in commercial plans were issued in November 2013; proposed rules pertaining to Medicaid managed care and Medicaid expansion plans were issued in March 2016. For more history on parity, see the Health Affairs Policy Brief on Mental Health Parity.
Fulfilling the promise of parity requires robust enforcement efforts at the state level. While state insurance commissioners are tasked with enforcing the law, states and advocates have pursued multiple strategies for securing insurance plan coverage that complies with parity. See below for resources and case studies on parity enforcement in the states.
- Understanding the Parity Law: Legal Action Center published a guide to the federal parity law in 2016. It breaks down health insurance requirements for addictions and mental health care.
- Tracking parity activities in the states: The Kennedy Forum and the Scattergood Foundation have established ParityTrack, a website providing information on states’ parity implementation efforts. The site currently offers information on 5 states; additional states will be added over time.
- Working with state Attorneys General on parity lawsuits: This webinar, held by the National Council, provided case studies and strategies for working with State Attorneys General on lawsuits to ensure parity enforcement.
- Strategies for enforcing parity in your state: These slides, produced by the Legal Action Center, walk through the major provisions of the law and implementing regulations, and provide suggestions on how to work at the state level to develop a parity enforcement plan.
- Medicaid Managed Care Parity, Final Rule: In March, 2016 CMS published final regulations outlining how the 2008 Mental Health Parity and Addiction Equity Act applies to state Medicaid and Children’s Health Insurance programs. This final rule extends parity to more than 23 million Americans covered by these important programs. Read our coverage here.
- CMS Parity Compliance Toolkit Applying Mental Health and Substance Use Disorder Parity Requirements to Medicaid and Children’s Health Insurance Programs provides detailed information and guidance to help states assess compliance with the final Medicaid/Children’s Health Insurance Program (CHIP) parity rule.
- FY2017 MHPAEA Enforcement Fact Sheet: This fact sheet summarizes the parity enforcement activities of the Employee Benefits Security Administration (EBSA), which relies on its 400 investigators to review health plans for compliance with MHPAEA.
- DOL 2018 Report to Congress: Pathway to Full Parity: This report summarizes DOL’s activities to further parity implementation and provides a roadmap of DOL vision for the future to minimize parity violations.
- 2018 MHPAEA Self-Compliance Tool: The goal of this self-compliance tool is to help group health plans, plan sponsors, plan administrators, group and individual market health insurance issuers, state regulators and other parties determine whether a group health plan or health insurance issuer complies with MHPAEA.
- Short-term Health Plans, Final Rule: In August, 2018, the Trump Administration issued a final rule permitting the sale of limited and short-term health coverage plans. These plans are exempt from important provisions including parity requirements for mental health and addiction services. Read more on the rule here.
Tools to Help Consumers Navigate Parity and Health Plan Coverage
Below you will find tools to provide you with more information about the parity law and advice on how to select the health coverage that fits your needs. These documents, developed by the National Council in partnership with the American Foundation for Suicide Prevention, will provide you additional information to help you understand plans sold in the health insurance exchange and employer sponsored plans:
- Welcome to the New Insurance Marketplace!
- Mental Health and Substance use Parity & the Affordable Care Act: Mental Health Services in the New Health Insurance Marketplace
- Appeals and Exceptions: How to Access Behavioral Health Services in Qualified Health Plans
- Your Mental Health and Substance Use Needs and Employer-Sponsored Coverage
- Mental Health and Substance Use Parity and Your Employer-Sponsored Coverage
- Appeals and Exceptions: How to Access Behavioral Health and Substance Use Services under Employer-Sponsored Insurance Plans
Parity Appeals Toolkit
The Kennedy Forum, with the Parity Implementation Coalition, released a toolkit to help you understand your rights under the Mental Health Parity and Addiction Equity law. The toolkit contains details on the requirements of the parity law and resources to help providers and consumers file successful appeals.
What are the most common ways your parity right could be violated? Find out here.
File an Official Complaint:
The National Council wants to make sure that group health plans covered by the law are complying with its requirements. If you suspect that your insurance plan is improperly restricting coverage of mental health and substance use disorder services, the U.S. Department of Health and Human Services has set up a Help Line to answer your questions or hear your concerns about your health plan’s compliance with the law. The number for the Help Line is: 1-877-267-2323 ext. 6-5511. In addition, Department of Labor benefits advisors are available to answer your questions about the parity law and provide assistance in obtaining your benefits. Call 1-866-444-3272 to express your concerns about your health plan’s compliance with the law.
In the News
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