Parity is about fairness. Americans with behavioral health conditions often have more difficulty getting the treatment and services they need when compared to individuals seeking other medical care. Explore parity-related information at the Federal level regarding legislation, statutes, and regulatory actions since the Federal Parity Law was passed in 2008.
Federal Parity Law
The Federal Parity Law includes protections for insurance coverage of mental health conditions and substance use disorders. The Federal Parity Law does not require insurance plans to cover behavioral health treatment, but if they do cover behavioral health treatment, the coverage must be to equal to other medical coverage. The law forbids insurance plans from using quantitative treatment limitations and financial requirements for behavioral health services that are less favorable than those in place for other medical services. Plans are forbidden from using non-quantitative treatment limitations (NQTLs) more restrictively for behavioral health services than how they are used for other medical services. Examples of NQTLs include prior authorization, step therapy,and various utilization review techniques, among others.
The Federal Parity Law currently applies to most types of health insurance offered in the country. However, there are some notable exceptions, like Medicare, for example.
The Federal Parity Law sets the baseline for protection of parity rights when both the federal law and state parity lawsapply to an insurance plan. If a plan is covered by the Federal Parity Law, people will get at least the level of rights afforded by the federal law. If a state law gives even more rights to the consumer, then it supersedes the federal law.
There are two federal laws that have significant implications for parity: the Mental Health Parity and Addiction Equity Act of 2008 (known as the Federal Parity Law ) and the Affordable Care Act (ACA). The Federal Parity Law built upon an older, less extensive federal law, and the ACA has expanded the scope of the Federal Parity Law. There is also pending legislation in Congress that could amend the Federal Parity Law.
The federal agencies responsible for enforcing the Federal Parity Law are the Department of Labor (DOL), the Department of Health and Human Services (HHS), and the Department of the Treasury (DoT). These agencies issued a final rule on the federal law in November of 2013. The Centers for Medicaid and Medicare Services (CMS) Issued a proposed rule on the federal law regarding Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (benchmark and benchmark equivalent plans), and the Children’s Health Insurance Program (CHIP).