The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that brought some needed equity to the way insurance companies reimburse providers and patients for mental health care and substance use disorder (MH/SUD) treatment and reimbursement for medical/surgical care.
This includes things like copay requirements and visit and other treatment limits – including lifetime caps. They can’t be more restrictive for MH/SUD treatment than for medical care.
In the years since its enactment, there have been changes in the law that have expanded the types of insurers that are required to comply with it. The original law applied to group health plans only. The Affordable Care Act (ACA) of 2010 expanded the requirements to small group and many individual plans as well.
What do the new rules cover?
Just this September, several federal agencies collectively announced new final rules for the MHPAEA. The new rules are intended to further ensure that patients covered under both group and individual insurance plans “who seek treatment for covered MH conditions or SUDs do not face greater burdens on access to benefits for those conditions or disorders than they would face when seeking coverage for the treatment of a medical condition or a surgical procedure” and to “address barriers to access,” according to the Centers for Medicare and Medicaid Services (CMS).
The final rules:
- Clarify that those seeking MH/SUD care shouldn’t face more restrictions than those seeking surgical and other medical care
- Reinforce the provision that insurers can’t use more restrictive non-quantitative treatment limitations (NQTLs) for MH/SUD benefits than for medical benefits as long as they have the same classification. This would include things like requiring pre-approval.
- Codify the current requirement that insurers do analyses to determine the effect of NQTLs on benefits
Insurers are required to conduct these NQTLs analyses under the MHPAEA as well as a 2021 appropriations law.
As one administration comes to an end and another one begins in January, it’s important for medical providers as well as patients to understand the protections codified in the law to help ensure that those who seek MH/SUD care and those who provide it don’t face insurance disadvantages that have in the past been part of the stigma surrounding this type of care.
It remains to be seen, of course, what will happen as the three agencies that crafted the final rules (the Departments of Health and Human Services, Treasury and Labor) come under new leadership. If you have questions or concerns, experienced legal guidance can help provide clarity.