Substantial Improvements to Mental Health and Substance Use Disorder Coverage in Response to the Mental Health Parity and Addiction Equity Act of 2008. Requirements of MHPAEA

11/01/2013

MHPAEA requires employer-based group health plans and group health insurance issuers to ensure that financial requirements (e.g., copayments, deductibles) and treatment limitations (e.g., visit limits) applicable to MH/SUD benefits are no more restrictive than the predominant financial requirements or treatment limitations applied to substantially all medical/surgical benefits. This standard was added to preexisting law established in the Mental Health Parity Act of 1996 which required parity in aggregate lifetime and annual dollar limits for mental health benefits and medical and surgical benefits.

The parity statute does not mandate coverage of either mental health or substance use disorder benefits (although some plans are subject to state benefit mandate laws).

The IFR also specified that separate cumulative financial requirements like deductibles or out-of-pocket maximums or separately cumulative quantitative treatment limitations are also not permissible.

The rule points out that there are other types of treatment limits, referred to as NQTLs, to which parity requirements apply. These NQTLs are not expressed numerically but involve management and administrative practices that can limit the scope or duration of benefits. Examples include medical necessity standards, utilization management techniques, prescription formulary design, and standards for admissions to provider networks.

 

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