What are common examples of parity violations?

The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 intended to address the disparities in how insurance providers dealt with psychiatric illnesses including substance use disorders compared to non-psychiatric disorders.

Parity means that financial requirements, such as copayments, and treatment limits, such as how many visits the insurance provider will pay for, must be comparable for physical health and Mental Health (MH)/ Substance Use Disorder (SUD) services. Parity also applies to rules related to how MH/SUD treatment is accessed and under what conditions treatment is covered (such as whether patients need permission from their insurance plan before starting treatment). These include Copayments, Deductibles, Yearly visit limits, Need for prior authorization and Proof of medical necessity. The act dictates that third party payers may not treat psychiatric disorders including substance use disorders any differently than they would treat other medical conditions such as diabetes or hypertension. For example, insurance company may not impose limitations to the number of sessions with a psychiatrist they cover, and may not require stricter coverage requirements for treatments of opioid use disorder than of diabetes. On a state level, MHPAEA is best implemented by having collaboration with multiple other agencies and stakeholder groups, including state health and behavioral health departments, consumers, consumer advocacy groups, providers, and other state agencies. Interacting closely with federal agencies early on to facilitate an understanding of the law also ensured that any existing state parity regulations complemented current federal rules. However, states also noted that actual improvements in access require explicit attention to adequacy of provider availability. States emphasized that evaluating network adequacy and addressing workforce issues are critical components of improving behavioral health care delivery within the context of parity implementation.

Access “Know Your Rights: Parity for Mental Health and Substance Use Disorder Benefits” at: https://pcssnow.org/resource/know-rights-parity-mental-health-substance-use-disorder-benefits/

More information can be found here:
https://store.samhsa.gov/product/Approaches-in-Implementing-the-Mental-Health-Parity-and-Addiction-Equity-Act-Best-Practices-from-the-States/SMA16-4983

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