This is the seventh in a series of blog posts celebrating the benefits that the Affordable Care Act (ACA) provides to people with disabilities. For the full list of prior and upcoming blog posts, see Friday’s news item.
The ACA Provides for Mental Illness and Substance Use Disorder Health Insurance “Parity”
For decades, health insurance plans discriminated against coverage of treatments for mental illness (MI) and Substance Use Disorder (SUD). Treatments were not covered; lifetime and annual visit limits applied; and individuals seeking these treatments incurred much higher co-payments and deductibles. “Parity” in health insurance design and practice requires health plans to apply similar rules to MI & SUD benefits as they do for medical/surgical (physical health).
Prior to the ACA, the federal government passed two laws which prohibited forms of MI and SUD discrimination. These two laws and their basic intents were:
- Mental Health Parity Act of 1996: an effort to eliminate visit limits and higher out-of-pocket obligations for mental illness in private employment-based group health plans.
- Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008: application of parity standards in private employment-based group health plans in greater details and applied to substance use disorders (SUDs).
The Affordable Care Act (ACA) of 2009 made further changes for the treatment of MI and SUD. Qualified health plans sold on the ACA marketplace must comply with MHPAEA requirements. Additionally, the ACA extended the protections of the MHPAEA to individual insurance plans and small group health plans and Medicaid and Medicare policies were made more consistent with concepts of parity.
While the ACA has made an improvement as it relates to the treatment of MI and SUD, a number of problems still remain. These include:
- Application of discriminatory “non-quantitative treatment limits,” that include definitions of medical necessity, medical management standards, medication formulary restrictions, provider network adequacy, in-network requirements, prior authorization paperwork and timelines, special provider fees, and “step therapies.”
- State government insurance agencies, generally, do not actively enforce the parity requirements.
- The federal government doesn’t effectively enforce the parity requirements.
- No real uniform health plan transparency and compliance reporting.
Sources of information include:
- Department of Labor Mental Health Parity and Addiction Equity Act Interim Final Rule Comments
- SAMSHA Parity of Mental Health and Substance Use Benefits with Other Benefits: Using Your Employer-Sponsored Health Plan to Cover Services
- NAMI: Mental Health Parity Remains A Challenge 10 Years After Landmark Law
- Legal Action Center Resources on Parity