The Current State of Mental Health Parity

Mental health parity refers to coverage of mental health and substance use services on the same terms and conditions as other types of medical care.[1]

The current state of mental health parity across the country has its roots in federal laws.

  • The original Mental Health Parity Act (MHPA) was signed into law in 1996. The MHPA provided that large group health plans cannot impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical/surgical benefits. [2]
  • In 2008, The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) built upon existing protections under the original MHPA but added parity requirements to substance use disorders.[3]
  • The MHPAEA originally applied only to group health plans and group health insurance coverage but was later amended by the Affordable Care Act in 2010 to include individual health coverage.[4]
  • Self-insured non-federal government plans or self-insured small private employers that have 50 or fewer employees are exempted from the MHPEA.[5]
  • While the MHPAEA was enacted in order to address the growing disparity of services between mental and physical health, concerns still remain. Fine-tuning language such as “scope of services” and “continuum of care,” greater compliance with disclosure requirements, and implementing new statutory requirements for increased cost exemptions are a few potential improvements articulated by advocates of mental health reform, yet no recent movement to reauthorize the act has been present.[6]

Enforcement of certain MHPAEA provisions has proven difficult throughout the years following the law’s enactment, so states have begun addressing these specific concerns despite not all states having specific laws on the books.

  • While California and New York have been national leaders in advocating for mental health parity through state legislation and litigation, Connecticut through SB 1085 (2015) required that individual health plans include coverage for “nervous disorders.”[7]
  • Other states  - Rhode Island, Virginia, and Wyoming - have enacted laws designed to better align state and federal parity laws and regulations, with Virginia mandating that their Bureau of Insurance require annual reports from insurers on denied claims and other logistical issues that involve mental health coverage.[8]
  • States such as Louisiana have put into place efforts to ensure patients admitted under an emergency certificate will not be issued a medical necessity denial for inpatient behavioral health services by insurers.[9]
  • Furthermore, a few states have also extended parity to specific conditions. Colorado and North Carolina included autism while Missouri included eating disorders.[10]
 

[1] “State Mental Health Legislation, 2015: Trends, Themes, and Effective Practices.” National Alliance on Mental Illness. http://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/State-Mental-Health-Legislation-2015/NAMI-StateMentalHealthLegislation2015.pdf

[2] “The Mental Health Parity and Addiction Equity Act.” Centers for Medicare and Medicaid Serviceshttps://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/mhpaea_factsheet.html

[3] Ibid.

[4] Ibid.

[5] Ibid.

[6] “Fact Sheet: The Mental Health Parity and Addiction Equity Act of 2008.” United States Department of Labor. https://www.dol.gov/ebsa/newsroom/fsmhpaea.html

[7] “State Mental Health Legislation, 2015, p. 6

[8] Ibid.

[9] Ibid.

[10] Ibid.