The Mental Health Parity and Addiction Act (MHPAEA) is a federal law that requires group health plans to provide mental health and substance abuse (MH/SUD) benefits commensurate with the medical and surgical benefits offered. This legislation does not require health plans to provide mental health and substance abuse (MH/SUD) benefits, but if such benefits are provided, they must be at least as restrictive as the medical/surgical benefits of the plan.
How does MHPAEA work?
The MHPAEA was originally set up to prevent health insurance companies from imposing more treatment restrictions (such as the number of visits) or financial requirements (such as the amount of co-pay) on mental health and substance abuse services. Prior to MHPAEA, a health plan may provide an unlimited number of medically necessary appointments to a dermatologist, but it only covers five psychiatric treatments per year. When MHPAEA is in place, health care plans should cover psychiatric services in the same way as they cover other necessary health care services.
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Advanced Search Basic information on implementing MHPAEA can be found on the Centers for Medicaid and Medicare Services (CMS) websites. The premise of the law is quite simple, but several of the required acts can make the implementation of the law a little more complicated.
MHPAEA affects several aspects of health care, including financial requirements such as contributions and deductibles, and treatment restrictions such as number of visits and types of care. If the group health plan includes both MH/SUD and medical/surgical benefits, the MH/SUD benefits ‘shall not be more restrictive than the prevailing economic requirements or treatment restrictions applicable to substantially all medical/surgical benefits’. This simply means that mental health services should be subject to the same financial requirements and treatment restrictions for more than half of the medical services covered.
The following examples can help illustrate MHPAEA in practice:
- Joint Countries: If the total premium for an insurance plan is $ 25 for most of the medical services covered by the plan, the total salary for a mental health or substance abuse service should not exceed $ 25. For example, a person who pays $ 25 for an appointment with a gynecologist or primary care physician can expect to pay $ 25 for a psychiatrist.
- Deductibles: In the case of deductibles, MHPAEA requires MH/SUD services and medical/surgical services to be combined to participate in one deductible plan instead of two separate deductibles. If a person with a $ 500 deductible spends $ 200 on psychotherapy sessions and $ 200 on medical laboratory tests, both should contribute the same $ 500 deductible.
- Types of care: If the plan covers both outpatient and inpatient and surgical services, it should also cover hospital and outpatient care for MH/SUD services. A person who needs hospital treatment for heart surgery should also cover admission to a heart hospital with a hospital drug and alcohol treatment facility . In addition, the maximum number of hospital days covered by most medical/surgical hospital services should also apply to mental health and substance abuse services.