In 2008, Congress enacted the Mental Health Parity and Addiction Equity Act (“MHPAEA” or the “Act”). Subsequently, in 2013, the Departments of Treasury, Labor and Health and Human Services issued the first rules implementing the Act. This Act applies to certain public and private health insurance plans, including employer group plans and requires that benefits offered for mental health and substance abuse conditions be on a par with those offered for medical and surgical conditions.
The Act
The MHPAEA does not require plans that don’t already do so to offer mental health and/or substance abuse disorder benefits. The Act only applies to a plan that already offers mental health and substance abuse benefits in addition to medical and surgical benefits. If the plan does not offer any mental health or substance abuse disorder benefits, then compliance with the MHPAEA is not required.
If the MHPAEA applies to a plan, then the plan must offer mental health and/or substance abuse disorder benefits in the same manner for which it offers medical and surgical benefits. Insurers must apply financial requirements (copayments, deductibles) and treatment limitations (number of visits, scope of treatment) to mental health or substance abuse disorder benefits that are no more restrictive than those applied to substantially all medical and surgical benefits in the same classification.
Potential Impact on Providers of the Mental Health
Parity and Addiction Equity Act