{"id":355849,"date":"2016-04-04T10:46:17","date_gmt":"2016-04-04T15:46:17","guid":{"rendered":"https:\/\/content.findlaw-admin.com\/ability-law\/healthcare\/patient-rights\/what-is-the-mental-health-parity-act.html"},"modified":"2024-03-19T16:45:11","modified_gmt":"2024-03-19T21:45:11","slug":"what-is-the-mental-health-parity-act","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/healthcare\/patient-rights\/what-is-the-mental-health-parity-act.html","title":{"rendered":"What Is the Mental Health Parity and Addiction Equity Act?"},"content":{"rendered":"\n<div class=\"wp-container-core-columns-is-layout-9d6595d7 fl-sectionWithSidebar fl-container fl-flex fl-flex-wrap fl-gap30\">\n    \n    <div class=\"fl-page-articles fl-section-main fl-section-main-full-width\">\n        <h1 class=\"fl-no-margin-top\">What Is the Mental Health Parity and Addiction Equity Act?<\/h1>\n<section class=\"fl-gutenberg-byline\">\n    <div class=\"fl-gutenberg-byline-content\">\n                    By <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/melissa-mccall-j-d\/\">Melissa McCall, J.D.<\/a> | Legally reviewed by <a\n                href=\"https:\/\/www.findlaw.com\/company\/our-team\/susan-richmond-esq\/\">Susan Mills Richmond, Esq.<\/a>\n                | Last updated\n        <time>\n                            March 19, 2024\n                    <\/time>\n    <\/div>\n\n    \n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-legally-reviewed\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Legally Reviewed\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>This article has been written and reviewed for legal accuracy, clarity, and style by <a href=\"https:\/\/www.findlaw.com\/company\/our-team.html\">FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with <a href=\"https:\/\/www.findlaw.com\/company\/company-history\/editorial-policy.html\">our editorial standards<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n\n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-fast-checked\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Fact-Checked\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>The last updated date refers to the last time this article was reviewed by FindLaw or one of our <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/contributing-authors.html\">contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please <a href=\"https:\/\/lawyers.findlaw.com\/?fli=bylinelink\" target=\"_blank\" rel=\"noopener\">contact an attorney in your area<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n<\/section>\n<p>Mental health is a part of your health. It shouldn&#8217;t be treated differently than physical health, although many view it as such. Congress passed the&nbsp;<a href=\"https:\/\/www.cms.gov\/marketplace\/private-health-insurance\/mental-health-parity-addiction-equity\" target=\"_blank\" rel=\"noopener\">Mental Health Parity and Addiction Equity Act<\/a>&nbsp;(MHPAEA) in 2009. This federal parity law ensures that insurers offering mental health coverage treat mental health as they do physical health. Under the MHPAEA, health insurers must provide equal benefits for mental health and physical health conditions and providers.<\/p>\r\n<p>This FindLaw article explores coverage for mental health and substance use disorder services.<\/p>\r\n<h2>Mental Health Coverage<\/h2>\r\n<p>Millions of Americans struggle every year with mental illness and substance use disorder. The&nbsp;<a href=\"https:\/\/www.nami.org\/home\" target=\"_blank\" rel=\"noopener\">National Alliance on Mental Illness<\/a>&nbsp;(NAMI) is a mental health advocacy organization. According to NAMI, the following groups experience some form of mental illness each year:<\/p>\r\n<ul>\r\n<li>American adults \u2013 23%<\/li>\r\n<li>American youth \u2013 16%<\/li>\r\n<\/ul>\r\n<p>Mental health practitioners provide mental health services to help this population manage their illness. Coverage of mental health and substance use disorders includes a mix of inpatient and outpatient treatment options.<\/p>\r\n<h3>Mental Health Conditions<\/h3>\r\n<p>The phrase &#8216;mental health conditions&#8217; is broad. It includes, but is not limited to, the following:<\/p>\r\n<ul>\r\n<li>Depression<\/li>\r\n<li>Anxiety disorders<\/li>\r\n<li>Substance abuse<\/li>\r\n<li>Personality disorders<\/li>\r\n<li>Anorexia and bulimia<\/li>\r\n<li>Schizophrenia<\/li>\r\n<li>Bipolar disorders<\/li>\r\n<\/ul>\r\n<h2>Mental Health and Insurance<\/h2>\r\n<p>Before the MHPAEA, health plans offered different benefits for mentally ill patients compared to physical conditions. Insurers often imposed less favorable benefit limitations on behavioral health than medical health. For example, a plan might have different co-pays for mental health care than medical care.<\/p>\r\n<p>The MHPAEA&nbsp;<a href=\"https:\/\/www.cms.gov\/marketplace\/private-health-insurance\/mental-health-parity-addiction-equity#Introduction\" target=\"_blank\" rel=\"noopener\">originally applied<\/a>&nbsp;to group health plans and group health insurance coverage. This changed after the passage of the&nbsp;<a href=\"https:\/\/www.findlaw.com\/healthcare\/patient-rights\/obamacare-basics-understanding-the-affordable-care-act.html#:~:text=The%20Affordable%20Care%20Act%20is,of%20the%20health%20insurance%20industry.\">Affordable Care Act<\/a>&nbsp;(ACA). The ACA amended the MHPAEA to include individual health insurance coverage.<\/p>\r\n<h2>MHPAEA Requirements<\/h2>\r\n<p>The MHPAEA requires mental health and substance abuse coverage to be at&nbsp;<a href=\"https:\/\/www.samhsa.gov\/newsroom\/press-announcements\/20220427\/hhs-new-mental-health-substance-use-disorder-benefit-resources#:~:text=The%20Mental%20Health%20Parity%20and,for%20medical%20and%20surgical%20benefits.\" target=\"_blank\" rel=\"noopener\">parity with medical and surgical coverage<\/a>. In other words, a qualified insurance plan can&#8217;t make mental health and substance abuse coverage more complex and more expensive than medical coverage.<\/p>\r\n<p>&quot;Parity&quot; means that elements of insurance coverage are fundamentally comparable. For example, a plan wouldn&#8217;t meet parity requirements if the length of inpatient visits covered are shorter for mental health treatment than for medical treatment.<\/p>\r\n<h3>Elements of Insurance Coverage<\/h3>\r\n<p>The MHPAEA&nbsp;<a href=\"https:\/\/www.cms.gov\/marketplace\/private-health-insurance\/mental-health-parity-addiction-equity\" target=\"_blank\" rel=\"noopener\">distinguishes<\/a>&nbsp;between quantitative and non-quantitative treatment limitations. Quantitative treatment limitations look at numbers and include things like number of visits. Non-quantitative treatment limitations include things like prior authorizations.<\/p>\r\n<p>Qualified insurance plans must guarantee that coverage is at parity for the following:<\/p>\r\n<ul>\r\n<li>Co-pays<\/li>\r\n<li>Coinsurance<\/li>\r\n<li>Cost-sharing<\/li>\r\n<li>Deductibles<\/li>\r\n<li>Reimbursements<\/li>\r\n<li>Numerical treatment limitations<\/li>\r\n<li>Out-of-pocket maximums<\/li>\r\n<li>Inpatient and outpatient visit limits<\/li>\r\n<li>Prior authorization<\/li>\r\n<li>Out-of-network coverage<\/li>\r\n<\/ul>\r\n<p>Medical necessity criteria (used to determine whether insurance will pay for treatment)<\/p>\r\n<h2>MHPAEA Parity Requirement Exemptions<\/h2>\r\n<p>The&nbsp;<a href=\"https:\/\/www.hhs.gov\/healthcare\/about-the-aca\/index.html\" target=\"_blank\" rel=\"noopener\">Affordable Care Act<\/a>&nbsp;(ACA) impacted many areas of the MHPAEA by extending the parity requirements to apply to more plans. Before the implementation of the ACA, small employer plans weren&#8217;t subject to the MHPAEA. Also, parity requirements didn&#8217;t apply to plans without mental health coverage.<\/p>\r\n<p>Today, insurance plans can&#8217;t omit mental health coverage\u2014it is an essential health benefit. Non-exempt insurance plans must include mental health care and substance use disorder benefits. Such plans must also meet parity requirements.<\/p>\r\n<h3>Exempt Health Insurance Plans<\/h3>\r\n<p>MHPAEA requirements don&#8217;t apply to the following health insurance plans:<\/p>\r\n<ul>\r\n<li>Retiree plans<\/li>\r\n<li><a href=\"https:\/\/www.medicare.gov\/\" target=\"_blank\" rel=\"noopener\">Medicare<\/a><\/li>\r\n<li>Some&nbsp;<a href=\"https:\/\/www.medicaid.gov\/medicaid\/benefits\/bhs\/index.html\" target=\"_blank\" rel=\"noopener\">Medicaid<\/a>&nbsp;plans<\/li>\r\n<li>Government-sponsored self-insured plans<\/li>\r\n<li>Small group insurance plans<\/li>\r\n<li>Small employer plans created before March 23, 2010<\/li>\r\n<\/ul>\r\n<h2>State Mental Health Parity Laws<\/h2>\r\n<p>The MHPAEA is a federal parity law. State parity laws are often stricter about enforcing parity. For example,&nbsp;<a href=\"https:\/\/ag.ny.gov\/sites\/default\/files\/mental_health_parity_brochure.pdf\" target=\"_blank\" rel=\"noopener\">New York<\/a>&nbsp;has one of the more stringent parity laws among the states. New York State requires a minimum of 30 days of inpatient and 20 days of outpatient treatment for mental health. The law also defines those illnesses that health insurance companies must fully cover.<\/p>\r\n<p>Defining illnesses eliminates reliance on medical necessity criteria to avoid paying for mental health coverage.<\/p>\r\n<h2>Get Legal Help<\/h2>\r\n<p>If your health insurance plan doesn&#8217;t offer comparable mental health and substance use disorder treatments, you should get legal counsel. A health care attorney can help you understand applicable federal and state laws concerning mental health parity. Speak to an experienced&nbsp;<a href=\"https:\/\/lawyers.findlaw.com\/health-health-care-law\/?fli=dcta\" target=\"_blank\" rel=\"noopener\">healthcare attorney<\/a>&nbsp;today.<\/p>\r\n<div class=\"was-this-helpful\">\n    <div\n            class=\"was-this-helpful__question-container\"\n            aria-labelledby=\"was-this-helpful__question\"\n            role=\"group\"\n    >\n        <span\n                id=\"was-this-helpful__question\"\n                class=\"was-this-helpful__question fl-text-lg-bold\"\n        >Was this helpful?<\/span>\n        <button\n                class=\"was-this-helpful__button fl-text-sm\"\n                aria-label=\"Yes\"\n                value=\"yes\"\n        >\n            <span class=\"was-this-helpful__button-text fl-text-bold\">Yes<\/span>\n            <i class=\"was-this-helpful__button-icon\">\n                <svg width=\"22\" height=\"22\" viewBox=\"0 0 22 22\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                  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19.5587 9.87871 20.1213C10.4413 20.6839 11.2044 21 12 21L16 12V0.999995H4.72003C4.2377 0.994543 3.76965 1.16359 3.40212 1.47599C3.0346 1.78839 2.79235 2.22309 2.72003 2.7L1.34003 11.7C1.29652 11.9866 1.31586 12.2793 1.39669 12.5577C1.47753 12.8362 1.61793 13.0937 1.80817 13.3125C1.99842 13.5313 2.23395 13.7061 2.49846 13.8248C2.76297 13.9435 3.05012 14.0033 3.34003 14H9.00003Z\"\n                              stroke=\"#666666\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/>\n                    <\/g>\n                    <defs>\n                        <clipPath id=\"clip0_604_3423\">\n                            <rect width=\"22\" height=\"22\" fill=\"white\"\/>\n                        <\/clipPath>\n                    <\/defs>\n                <\/svg>\n            <\/i>\n        <\/button>\n    <\/div>\n    <span class=\"was-this-helpful__taken-action fl-text-sm-bold\"><\/span>\n    <div class=\"was-this-helpful__feedback-container\">\n        <div 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<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>The Mental Health Parity and Addiction Equity Act ensures comparable coverage for physical and mental health issues. 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