The Mental Health Parity and Addiction Equity Act (federal parity law) was enacted in 2008 and requires insurance coverage for mental health conditions, including substance use disorders, to be no more restrictive than insurance coverage for other medical conditions. Insurers and health plans have been able to comply with the more straightforward aspects of the law that relate to cost sharing and numerical limits on treatment (like annual inpatient day limits). However, some plans have struggled to meet the more complex components of the law that govern how they design and apply managed care practices such as prior authorization, reimbursement rate setting, and network design, among many others.
In December of 2020, Congress enacted within the Consolidated Appropriations Act (CAA) new provisions that require insurers and health plans to perform comparative analyses showing that they comply with the managed care provisions of MHPAEA. Insurers and health plans must now make these analyses available to state regulators and the U.S. Department of Labor upon request beginning February 10, 2021.
APA was instrumental in the passage of the federal parity law and has worked diligently to see it fully implemented. APA supports Congressional efforts to improve compliance with the law. APA works closely with members of Congress and their staff as they consider various methods for improving implementation and compliance. This mirrors APA's efforts to work with state legislatures to advance parity implementation for the health plans that states can regulate.
APA's new tool to help state insurance regulators enforce parity with insurers.