The Mental Health Parity and Addiction Equity Act (MHPAEA) is a U.S. federal law that was enacted in 2008 to address disparities between mental health and substance use disorder (MH/SUD) benefits and medical/surgical benefits in health insurance coverage. The law aims to ensure that health insurance plans provide equal coverage for mental health and substance use treatment as they do for medical and surgical treatments. Here are the key provisions of the MHPAEA:
Scope of Coverage: The law requires that health insurance plans that offer mental health or substance use disorder benefits provide coverage that is no more restrictive than the coverage provided for medical and surgical benefits.
Financial Requirements: This provision requires that deductibles, copayments, coinsurance, and out-of-pocket maximums for mental health and substance use disorder services must be at parity with those for medical and surgical services. In other words, insurance companies cannot impose higher financial barriers for mental health and substance use treatments.
Treatment Limitations: The MHPAEA ensures that treatment limitations, such as the number of visits, days of coverage, or other restrictions on mental health and substance use disorder services, are no more restrictive than those for medical and surgical services.
Non-Quantitative Treatment Limitations (NQTLs): Non-quantitative treatment limitations refer to any additional restrictions or guidelines placed on mental health and substance use disorder treatments that are not based on specific numerical limits. The MHPAEA prohibits insurance plans from imposing NQTLs that are more stringent for MH/SUD benefits than for medical/surgical benefits.
Types of Coverage: The MHPAEA applies to group health plans sponsored by employers with 50 or more employees and to individual health insurance policies. It also covers Medicaid and the Children's Health Insurance Program (CHIP).
Expanded Definitions: The law expanded the definitions of mental health and substance use disorder services to include a wide range of treatments, including outpatient, inpatient, and emergency care, as well as rehabilitative and preventive services.
The MHPAEA aims to end discrimination against individuals seeking mental health and substance use disorder treatment by ensuring they have equal access to necessary care. It helps remove financial barriers and treatment limitations, allowing people to seek the help they need without facing additional obstacles due to their mental health or substance use condition.