Mental Health Parity Act

The MHPA applies to group health plans for plan years beginning on or after January 1, 1998.[1] The original sunset provision provided that the parity requirements would not apply to benefits for services furnished on or after September 30, 2001.[1] It was extended six times, with the final extension running through December 31, 2007. Insurers promptly were able to "circumvent" the consumer protections arguably intended in the legislation by imposing maximum numbers of provider visits and/or caps on the number of days an insurer would cover for inpatient psychiatric hospitalizations. In essence, the law had little or no effect on mental health coverage by group insurance plans. The rider on TARP prohibits all group health plans that offer mental health coverage from imposing any greater limit on co-pays, co-insurance, numbers of visits, and/or number of days covered for hospital stays due to mental health conditions. The rider legislation was the culmination of a long campaign fought by Sen. Paul Wellstone (D-MN) and his successors to enact mental health parity at the federal level. The new law's requirements will be phased in over several years. Still unsure is whether non-"biologically-based" mental illnesses such as PTSD and eating disorders are mandated to be covered by the new law.

Generally the act required parity of mental health benefits with medical and surgical benefits with respect to the application of aggregate lifetime and annual dollar limits under a group health plan. It provided that employers retain discretion regarding the extent and scope of mental health benefits offered to workers and their families, including cost sharing, limits on numbers of visits or days of coverage, and requirements relating to medical necessity.

The law also contained three exemptions:

No mental health coverage

Business that chose not to provide mental health coverage.

Small employers

Businesses with fewer than 50 employees.

Increased cost

Businesses that documented at least one percent increase in premiums due to implementation of parity requirements.[4]

Immediately after MHPA was enacted, insurers and employers began finding ways to circumvent the legislation. Larger emphasis on cost sharing, primarily implemented through higher copayments, deductibles, and out-of-pocket maximums, was one strategy used by insurers. In addition, limits and caps on the number of visits with a care provider or number of days in a hospital visit were imposed.[4]^: 201 MHPA also did not provide benefits for substance abuse and dependency issues.[5]^: 2 Lastly, MHPA contained a sunset provision that meant that the law would go out of effect after a certain date. The original sunset date was extended six times, through 2007.

Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008

Other short titles	Emergency Economic Stabilization Act of 2008 Energy Improvement and Extension Act of 2008 Heartland Disaster Tax Relief Act of 2008 Tax Extenders and Alternative Minimum Tax Relief Act of 2008
Long title	A bill to provide authority for the Federal Government to purchase and insure certain types of troubled assets for the purposes of providing stability to and preventing disruption in the economy and financial system and protecting taxpayers, to amend the Internal Revenue Code of 1986 to provide incentives for energy production and conservation, to extend certain expiring provisions, to provide individual income tax relief, and for other purposes.
Acronyms (colloquial)	MHPAEA
Enacted by	the 110th United States Congress
Effective	1 January 2010
Citations
Public law	Pub.L. 110–343 (text) (PDF)
Statutes at Large	122 Stat. 3765
Legislative history
Introduced in the House as H.R. 1424 by Patrick J. Kennedy (D-RI-1) on 9 March 2007 Committee consideration by Energy and Commerce; Education and Labor; Ways and Means Passed the House on 5 March 2008 (268 - 148) Passed the Senate on 1 October 2008 (74 - 25) with amendment House agreed to Senate amendment on 3 October 2008 (263 - 171) Signed into law by President George W. Bush on 3 October 2008

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted in October 2008[2] and took effect on 1 January 2009.[6][7] The main purpose of MHPAEA was to fill the loopholes left by the MHPA. The act requires health insurers as well as group health plans to guarantee that financial requirements on benefits, including co-pays, deductibles, and out-of-pocket maximums, and limitations on treatment benefits such as caps on visits with a provider or days in a hospital visit, for mental health or substance use disorders are not more restrictive than the insurer's requirements and restrictions for medical and surgical benefits.[5] MHPAEA only applies to insurance plans for public and private sector employers with over 50 employees and health insurance issuers who sell coverage to employers with more than 50 employees.[5]^: 1 Similar to MHPA, MHPAEA requires parity in terms of total annual dollar limits, as well as aggregate lifetime benefits. It is important to note however, that MHPAEA does not explicitly require that any insurance plan offer benefits for mental health and substance abuse disorders.[5]^: 1 Instead, it enacts parity rules for plans that choose to offer both medical and surgical benefits as well as mental health and substance abuse disorder benefits.[5]^: 1–2 This includes out-of-network benefits.[5]^: 3 If plans choose to offer both types of benefits, MHPAEA mandates that insurers define and make available specific criteria for medical necessity when it comes to mental health and substance abuse disorder benefits. In addition, MHPAEA also requires that insurers provide specific information and reasons in the event that reimbursement or payment for treatment is denied.[5]^: 3

• Beronio, Kirsten; Po, Rosa; Skopec, Laura; Glied, Sherry (20 February 2013). Affordable Care Act Expands Mental Health and Substance Use Disorder Benefits and Federal Parity Protections for 62 Million Americans (Report). Washington, DC: U.S. Department of Health and Human Services, Office of The Assistant Secretary for Planning and Evaluation.
• Internal Revenue Service; Employee Benefits Security Administration; Centers for Medicare & Medicaid Services (13 November 2013). "Final rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; technical amendment to external review for multi-state plan program: Final rules". Federal Register. 78 (219): 68239–96. PMID 24228295. 78 FR 68239
• Centers for Medicare & Medicaid Services (30 March 2016). "Medicaid and Children's Health Insurance Programs; Mental Health Parity and Addiction Equity Act of 2008; the Application of Mental Health Parity Requirements to Coverage Offered by Medicaid Managed Care Organizations, the Children's Health Insurance Program (CHIP), and Alternative Benefit Plans: Final rule". Federal Register. 81 (61): 18389–445. PMID 27029080. 81 FR 18389