Mental Health Parity (MHPAEA)

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that prevents health care service plans from imposing more restrictive benefit limitations on mental health and substance use disorder (MH/SUD) benefits than on medical/surgical coverage.

Health plans must ensure that financial requirements (such as co-pays and deductibles) and treatment limitations that apply to MH/SUD benefits are no more restrictive than the predominant requirements or limitations applied to medical and surgical benefits.

Louisiana Medicaid will complete a compliance review of all services by October 2, 2017. This initiative will ensure Louisiana Medicaid recipients receiving Medicaid and CHIP services receive equal access to physical and behavioral health care.

 

Legislative History 

  • 1996: Mental Health Parity Act of 1996 (MHPA) required certain commercial group health coverage to have parity in aggregate lifetime and dollar limits
  • 2008: Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) added substance use disorder services and required parity in treatment/financial limitations
  • 2013: Final mental health parity rules for commercial plans
  • 2016: Final mental health parity rules for Medicaid and CHIP managed care organizations (MCOs)

Classifications

Louisiana will place each Medicaid service in the following four classifications required in parity analysis:

  • Inpatient
  • Outpatient
  • Emergency Care
  • Prescription Drugs

Treatment Limitations to be Analyzed

  • Quantitative Treatment Limitations: Limits on benefits based on the frequency of treatment; examples include:
    • Number of visits
    • Days of coverage
    • Days in a waiting period, or
    • Other similar limits on the scope or duration of treatment
  • Non-Quantitative Treatment Limitations: No “hard limits” but limit the ability of a person to receive a certain service or level of services; examples include:  
    • Prior Authorization Processes
    • Concurrent Review
    • “Fail First” Policies

Additional Resources

Contact

For more info, please email [email protected].

Surgeon General Evelyn Griffin, MD

Secretary Bruce D. Greenstein

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