Mental Health and Substance Use Disorder Parity

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires health plans to provide benefits for mental health and substance use disorder (MH/SUD) treatment and services at a level equal to that which is provided for medical and surgical care. In early 2021, the Department of Community Health (DCH) explored additional report template options that facilitate both quantitative and nonquantitative reporting to expand the Medicaid health plan information previously required.  The reporting tool selected for use provides a comprehensive, standard document for health plans to demonstrate compliance with the mental health parity requirements under MHPAEA. The initial year of reporting represents the period July 1, 2019 to June 30, 2020 with annual reporting thereafter. The posted reports provide information for that period and will serve as a baseline for subsequent annual reports.

What is Mental Health Parity?

In March of 2016 the Centers for Medicare and Medicaid Services (CMS) finalized a rule to strengthen access to mental health and substance use disorder services for people with Medicaid, Children’s Health Insurance Program (CHIP), or Alternative Benefit Plan (ABP) coverage, similar to the requirements that were already in place for private health insurance plans.  In summary, the rule requires that Medicaid, CHIP, and ABP Managed Care Plans not impose more restrictive benefit limitations on mental health and substance use disorder (MH/SUD) benefits than on medical and surgical (M/S) benefits.  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.

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