The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that prevents most group health plans and health insurers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. This program provides an overview of the requirements of the MHPAEA, the practical implications for employees, and tips for the unwary for employers.
Plans must apply comparable copays for mental health (MH) and substance use disorder (SUD) care and physical health care. For example, there can be no limit on the number of visits for outpatient MH/SUD care, if there is no visit limit for outpatient physical healthcare. Parity also applies to rules related to how MH/SUD treatment is accessed and under what conditions treatment is covered. The following are subject to parity: Copayments, deductibles, yearly visit limits, prior authorization requirements, and proof of medical necessity. Parity requires that the processes related to plan benefit determinations be comparable.
Attend to hear a detailed analysis of the Act’s implications for employer benefits so you can better field client questions about this complex area.