Mental Health Parity Act (MHPA)

• TYPE OF PSYCHOLOGY: Biological bases of behavior, psychopathology, and psychotherapy

SIGNIFICANCE: Mental health parity is a healthcare policy endorsed by the US government through Public Law 110-343, which states that mental healthcare coverage must be equitable to physical healthcare coverage. Research indicates that a connection exists between mental and physical well-being; therefore, comprehensive, integrated insurance coverage that accounts for all aspects of healthcare is in the best interest of both the public and employers.

Introduction

The Mental Health Parity Act (MHPA), signed into law on September 26, 1996, was the first legislation requiring health insurance companies to cover mental health care at a specific amount, raising lifetime and annual limits. In 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) was approved as part of the US legislation known as Public Law 110-343, the Emergency Economic Stabilization Act of 2008. Often called the MHPA, this legislation prohibited health insurers from restricting mental healthcare and addiction treatment and required such to be equal to what is offered for physical healthcare. The intention was to establish functional equality for treating these types of problems.

In this law, mental healthcare refers to services for mental health conditions, while addiction treatment refers to services for substance use disordersconditions known as substance abuse and substance dependence. Thus, insurers could not charge higher co-pays or deductibles or impose limits on the frequency of treatment, number of doctor visits, or days of coverage on mental health and addiction benefits compared to other medical services. In addition, if the health plan provided coverage for medical or surgical services through providers not normally associated with the health plan—a policy known as out-of-network costs—it also had to do so for mental health and addiction. Finally, under the law, insurers could not require federal update coinsurance or set higher out-of-pocket limits for these services than other medical or surgical expenses within the health plan.

This law was created because the intentions of the previously passed MHPA had been circumvented through restrictions on specific terms related to services not covered in the law. The design of the 2008 law was to correct such problems. This law, however, did not mandate that health plans provide mental health or addiction coverage; it only required that if such services were provided, they had to be done so in a way that demonstrated equality with the physical healthcare benefits. Small businesses that employed between two and fifty employees were exempt from compliance with this law.

Treatment for mental health and addictions created significant cost-offset savings on future healthcare, meaning that if money was spent on treatment for problems when they were diagnosed, it would be saved in the end by preventing new or worsening problems. Furthermore, research indicated an association between treatment for such problems and improved workplace functioning and productivity. Given this fact, the 2008 law was created without the expectation of required coverage for mental health and addiction because of the cost savings and other benefits. Lawmakers assumed that mental health and addictive benefits would be offered because they were not only valuable benefits to employees but also financially wise investments for employers.

In 2010, clauses in the Patient Protection and Affordable Care Act (ACA) expanded mental health coverage for many insurance plans under MHPAEA, including smaller employers, many Medicaid-managed care programs, and all individuals covered under the Children’s Health Insurance Program (CHIP). In 2016, further guidance was provided in the Twenty-first Century Cures Act, and in 2021, Section 203 of Title II of Division BB of the Consolidated Appropriations Act signed in December 2020 went into effect. This required specific health insurance providers and certain healthcare plans to supply an analysis of the impact of all non-quantitative treatment limitations (NQTLs), including preauthorization for services and other fees and determinations associated with out-of-network services.

The US Departments of Health and Human Services (HHS), Labor, and the Treasury released amendments and additions to the MHPAEA in September 2024. These changes aimed to eliminate barriers to care for individuals seeking treatment for mental health or substance use disorders. These guidelines included an emphasis on using the same NQTLs for all health conditions, meaning insurance providers were prohibited from making it more difficult to access mental health or substance use care than to access care for an infection or broken leg.

Quality Healthcare Equals Integrated Healthcare

True health combines physical and mental well-being and freedom from addictions. Numerous sources related to psychophysiology and the interactions among health, stress, and psychological processes point to the importance of integrative healthcare. Further, epidemiology from around the world demonstrates that comorbidity, the condition in which a person has multiple disorders, frequently includes mixes of physical, mental, and addiction-related problems. When considering that stress also affects health and may exacerbate other conditions, the interdependence of successful treatment and attention to all these factors is underscored. As such, common sense dictates that good healthcare should allow for integration of and consistent attention to each of these aspects of health in the provision of treatment. Arbitrarily setting financial limits or other barriers could detract from the overall effectiveness and quality of care. Thus, from a mental health perspective, mental health parity laws became a logical outcome of the literature on and history of mind-body interactions.

Bibliography

Andersen, Ronald, et al. Changing the US Health Care System: Key Issues in Health Services Policy and Management. 4th ed. Jossey-Bass, 2014.

Bährer-Kohler, Sabine, and Blanca Bolea-Alamanac. Diversity in Global Mental Health: Gender, Lifespan, Access to Care, Treatment and Social Strata. Springer, 2019.

Chatterjee, Anjan, and Martha J. Farah. Neuroethics in Practice. Oxford UP, 2013.

Kelly, Timothy A. Healing the Broken Mind: Transforming America's Failed Mental Health System. New York UP, 2009.

Lovallo, William R. Stress and Health: Biological and Psychological Interactions. 2nd ed. Sage, 2004.

"Mental Health and Substance Use Disorder Parity." United States Department of Labor, www.dol.gov/agencies/ebsa/laws-and-regulations/laws/mental-health-and-substance-use-disorder-parity. Accessed 1 Oct. 2024.

O’Kane, Debra. Mental Health: A Pocket Guide. 4th ed. Elsevier, 2021.

Sapolsky, Robert M. Why Zebras Don’t Get Ulcers. 3rd ed. Holt, 2004.

Shally-Jensen, Michael. Mental Health Care Issues in America: An Encyclopedia. ABC-CLIO, 2013.

"The Mental Health Parity and Addiction Equity Act (MHPAEA)." US Centers for Medicare & Medicaid Services, 9 Sept. 2024, www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity#2024mhpaearegulations. Accessed 1 Oct. 2024.

"Understanding Parity: A Guide to Resources for Families and Caregivers." Substance Abuse and Mental Health Services Administration, 2021, store.samhsa.gov/sites/default/files/pep21-05-00-002.pdf. Accessed 1 Oct. 2024.