Parity Resource Center
A Guide to the Mental Health Parity and Addiction Equity Act (MHPAEA)
Welcome to ABHW’s comprehensive Mental Health Parity and Addiction Equity Act (MHPAEA) resource center.
As the leading health plan association working to improve access and quality of care for mental health and substance use disorders, we have been at the forefront of and an advocate for mental health and substance use disorder parity for more than 15 years.
ABHW was instrumental in drafting the legislative language of the initial MHPAEA of 2008, and our members have worked since then to implement parity for behavioral health services. ABHW remains committed to providing equitable coverage of mental health and substance use disorder treatment.
What is MHPAEA?
MHPAEA, short for the Mental Health Parity and Addiction Equity Act, is a landmark federal law that requires the equal treatment of mental health and substance use disorder benefits in insurance plans. It is designed to eliminate disparities between mental health care and medical/surgical care and address our country’s growing need for mental health and substance use disorder services in our country.
The Recently Proposed MHPAEA Regulation
On July 25, 2023, the U.S. Department of Labor (DOL), the U.S. Department of Health and Human Services (HHS), and the U.S. Department of Treasury (DOT) – collectively, “the Tri-Departments” – released the Mental Health Parity and Addition Equity Act (MHPAEA) Notice of Proposed Rulemaking (NPRM) and Technical Release. While ABHW is committed to working with the Tri-Departments to enhance and refine regulations governing mental health and substance use disorder parity, we have several concerns with the currently proposed regulation. Our priority recommendations to the Tri-Departments on the proposed rule include:
The Tri-Departments propose to reinterpret the parity statute to subject medical management techniques, called Non-Quantitative Treatment Limits (NQTLs), such as prior authorization and concurrent review, to the quantitative tests that are currently applied to financial limits, called quantitative treatment limits (QTLs), such as copays and deductibles. ABHW requests that the Tri-Departments rescind the proposal to apply the Substantially All – Predominant Test and maintain the current NQTL testing requirements.
a. Independent Professional Medical or Clinical Standards: ABHW requests that the Tri-Departments interpret independent professional medical or clinical standards broadly and provide examples of standards that would meet the exception. ABHW also encourages the Tri-Departments to provide further clarity and examples of situations that would meet this exception and what is required documentation.
b. Fraud Waste, and Abuse: ABHW requests that the Tri-Departments provide clear guidance specifying that health plans may use any reasonable methodology to determine how often the fraud, waste, and abuse data must be reanalyzed to show that the standard for reliance on the exception continues to be met.
c. ABHW Requests that the Tri-Departments Adopt Two Additional Exceptions: ABHW encourages the Tri-Departments to adopt an exception if a health plan applies a federal or state law to the design or operation of an NQTL and for factors designed to ensure the quality and safety of covered services.
The Tri-Departments’ enforcement powers do not permit them to require corrective action in the absence of noncompliance; ABHW, therefore, recommends that these sections be revised to apply only where the plan is unable to rebut the presumption of noncompliance that is triggered by a material difference in a required data measure.
Explore Our MHPAEA Resources
- ABHW Comments on the Centers for Medicare and Medicaid Services (CMS), Center for Medicaid and CHIP Services (CMCS) Request for Comments on Processes for Assessing Compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) in Medicaid and CHIP.
- MHPAEA Comment Letter: Read our recommendations to the Tri-Departments for the new MHPAEA proposed rules, submitted on October 17, 2023.
- Parity Insights: A Summary of ABHW’s Response to the MHPAEA Proposed Rule: We summarized our top recommendations from our comment letter.
- ABHW Response to the MHPAEA Technical Release: ABHW submitted comments for the Tri-Departments’ Request for Comment on Proposed Relevant Data Requirements for Nonquantitative Treatment Limitations (NQTLs) Related to Network Composition and Enforcement Safe Harbor for Group Health Plans and Health Insurance Issuers Subject to MHPAEA.
- MHPAEA Comment Extension Letter Statement: The below extension was issued on September 20, 2023, giving stakeholders much-needed additional time to respond more thoughtfully to the complexity of the proposed rule and technical release.
- MHPAEA Comment Extension Letter: We brought together partner organizations and health plan member companies to advocate for an extension of the Tri-Departments’ proposed rule and technical release.
- ABHW Responds to 2023 Mental Health Parity and Addiction Equity Act Report to Congress and Proposed Rule: Read our response to the release of the MHPAEA proposed rule and and report to Congress, submitted on July 26, 2023.
- Additional Regulatory Positioning: In addition to MHPAEA, we continue to advance federal policy and education for the public on mental health and substance use disorder care.
ABHW and MHPAEA In the News:
- Behavioral Health Business: Eager for Parity Reform, Outpatient Mental Health Should Expect to ‘Step Up’ Care Quality
- Mental Health Weekly: Proposed parity federal rule aims to boost MH coverage, increase service access
- Behavioral Health Business: ‘It’s A Huge Deal’: Behavioral Health Stakeholders Praise New Mental Health Parity Rule
- Bloomberg Law: White House Targets Insurers on Mental Health Law ‘Evasion’
- Bloomberg Law: Mental Health Parity Proposal Reaches White House for Review
- Bloomberg Law: Employers Await Mental Health Parity Help as Frustrations Build
- StarTribune: Parity laws haven’t solved access to mental health care in Minnesota