Bethesda, MD -- A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines the issue of mental health parity. The push to make coverage for mental health treatment equal to that of physical health has been on legislative to-do lists for some time, both in Congress and in state houses. This brief looks at the evolution of the Mental Health Parity Act, originally passed by Congress in 1996, as well as changes in mental health parity brought about by the implementation of the Affordable Care Act (ACA).
Topics covered in this brief include:
- What's the background? The original 1996 law had gaps: It failed to address treatment limits, limitations on the types of facilities covered, differences in cost-sharing, and the application of managed care techniques that continued to make coverage for mental health benefits less generous than physical health coverage. The brief explains how federal legislation sought to address some of these inequities, culminating in the 2008 passage of the Mental Health Parity and Addiction Equity Act (MHPAEA). The brief also explains how the ACA made this coverage possible for more Americans: MHPAEA was limited to beneficiaries in large group health plans, while the ACA extended parity in coverage to Americans in the individual exchanges and the small business exchanges. Also, the ACA defined mental health coverage as an essential benefit of health insurance, thereby going beyond the scope of the MHPAEA by not only requiring parity but mandating coverage.
- What's in the law? The brief details the specifics of the MHPAEA--how it eliminated treatment or visit limits that differed between mental health/substance use disorders coverage and medical/surgical benefits. Additionally, it details some of the regulatory changes since the enactment of the ACA--the regulation distinguishing between quantifiable treatment limits, such as visit limits and co-payments, and non-quantifiable treatment limitations, such as prior authorization, medical management standards, prescription drug formulary design, and others.
- What's the debate and what's next? As the brief explains, critics have argued that parity legislation alone is not enough to fix other underlying problems in how our health system provides access to treatment of mental health and substance use disorders. The ready supply and availability of mental health providers and services, compared to those of medical and surgical benefits, is another barrier to true parity. While the ACA has expanded the reach of the MHPAEA, there are also health plans--for example in the individual and small employer market--exempted from being required to expand. Looking ahead, there is concern that MHPAEA compliance may not be high on the priority list of state insurance commissioners, who will be preoccupied with overall ACA implementation.
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