The Mental Health Parity and Addiction Equity Act (MHPAEA, Pub.L. 110-343) makes it easier for Americans with mental health and substance use disorders to get the care they need by prohibiting certain discriminatory practices that limit insurance coverage for behavioral health treatment and services. MHPAEA requires coverage for mental health and substance use disorders to be no more restrictive than the coverage that generally is available 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
- Criteria for medical necessity determinations
Federal statutes require Medicaid and CHIP programs to comply with mental health and substance use disorder parity requirements. On March 29, 2016 CMS put on display at the Federal Register a final rule applying these requirements to Medicaid non-managed care benchmark and benchmark-equivalent plans as described in section 1937 of the Social Security Act (referred to in this rule as Alternative Benefit Plans, or ABPs), 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.
- Final Rule: Application of Mental Health and Substance Abuse Disorder Parity Requirements to Medicaid Managed Care, CHIP, and Benchmark Coverage (CMS-2333-F)
- Fact Sheet on the Final Rule
- Frequently Asked Questions (FAQs)
- CMS Press Release
- Slide presentation on the final rule
- Mental Health and Substance Use Disorder Parity Requirements to Medicaid & CHIP Presentation
- Frequently Asked Questions (FAQs) #2 (October 2017)
Below are resources that may assist Medicaid Directors to understand MHPAEA’s application to the Medicaid program.
- The Parity Compliance Toolkit provides detailed technical guidance and tools to help states understand and perform the parity analysis for each of the requirements of the final parity rules.
- The Parity Implementation Roadmap gives policymakers recommendations for how to approach parity implementation and compliance from a planning and operational perspective.
- Webinar slides presented on February 9, 2017 provided an overview of the content and use of the Parity Compliance Toolkit and Implementation Roadmap.
- Webinar slides presented on February 23, 2017 provided information on the Application of Mental Health and Substance Use Disorder Parity Requirements to Medicaid and Children’s Health Insurance Program.
- Webinar slides presented on March 9, 2017 provided information on the Application of Mental Health and Substance Use Disorder Parity Requirements to Medicaid and Children’s Health Insurance Program.