Mental Health and Substance Use Disorder Parity

Mental Health and Substance Use Disorder Parity

In 2008, the U.S. Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA), which required group health plans and health insurers that offer coverage for mental health and for substance use disorders to make these benefits no more restrictive than those for medical or surgical conditions.

In the years since, notable progress has been made, although challenges remain. For example, MHPAEA has yet to directly apply to all health plans. The complexity of MHPAEA legislation makes administration and enforcement challenging, even with the burden on insurers to demonstrate compliance. These difficulties are further compounded by the MHPAEA enforcement structure, which is shared by multiple federal departments. States also have a primary role in parity enforcement through their own regulatory agencies, and some states have passed additional parity legislation beyond MHPAEA.

A growing number of insurers have been fined for parity noncompliance by state and federal regulators in recent years. Sustained enforcement and additional legislative efforts are needed to close identified loopholes for MHPAEA to achieve its full potential.

This Editor’s Choice Collection highlights relevant articles from recent years, organized by parity legislation implementation, general short- or long-term impacts of parity legislation, and parity effects in specific populations.

PARITY LEGISLATION IMPLEMENTATION

Creation of a Longitudinal Legal Data Set to Support Legal Epidemiology Studies of Mental Health Insurance Legislation
Megan D. Douglas, J.D., Samantha Bent Weber, J.D., Claire Bass, J.D., Chaohua Li, M.P.H., Anne H. Gaglioti, M.D., M.S., Teal Benevides, Ph.D., M.S., Vahé Heboyan, Ph.D., M.S.
2022, Volume 73, Issue 3, pp 265–270

Enforcement of the Mental Health Parity and Addiction Equity Act: State Insurance Commissioners’ Statutory Capacity
Rachel Presskreischer, Ph.D., M.S., Colleen L. Barry, Ph.D., M.P.P., Adria K. Lawrence, Ph.D., Alexander McCourt, J.D., Ph.D., Ramin Mojtabai, M.D., Ph.D., Emma E. McGinty, Ph.D., M.S.
2023, Volume 74, Issue 6, pp 652–655

Holding Insurers Accountable for Parity in Coverage of Mental Health Treatment
Paul S. Appelbaum, M.D., and Joseph Parks, M.D.
2020, Volume 71, Issue 2, pp 202–204

How Do Private Health Plans Manage Specialty Behavioral Health Treatment Entry and Continuing Care?
Amity E. Quinn, Ph.D., Sharon Reif, Ph.D., Elizabeth L. Merrick, Ph.D., Constance M. Horgan, Sc.D., Deborah W. Garnick, Sc.D., Maureen T. Stewart, Ph.D.
2017, Volume 68, Issue 9, pp 931–937

GENERAL IMPACTS OF PARITY LEGISLATION

Acceptance of Insurance by Psychiatrists and Other Physicians, 2007-2016
Andrew D. Carlo, M.D., M.P.H., Anirban Basu, Ph.D., M.S., Jürgen Unützer, M.D., M.P.H., Neil Jordan, Ph.D.
2024, Volume 75, Issue 1, pp 25–31

Attitudes About Required Coverage of Mental Health Care in a U.S. National Sample
Donovan T. Maust, M.D., M.S., Michelle H. Moniz, M.D., M.S., Kara Zivin, Ph.D., Helen C. Kales, M.D., Matthew M. Davis, M.D., M.A.P.P.
2015, Volume 66, Issue 10, pp 1101–1104

Comparison of Medicaid Reimbursements for Psychiatrists and Primary Care Physicians
Tami L. Mark, Ph.D., M.B.A., William Parish, Ph.D., Gary A. Zarkin, Ph.D., Ellen Weber, J.D.
2020, Volume 71, Issue 9, pp 947–950

Federal Parity and Access to Behavioral Health Care in Private Health Plans
Dominic Hodgkin, Ph.D., Constance M. Horgan, Sc.D., Maureen T. Stewart, Ph.D., Amity E. Quinn, Ph.D., Timothy B. Creedon, M.A., Sharon Reif, Ph.D., Deborah W. Garnick, Sc.D.
2018, Volume 69, Issue 4, pp 396–402

Health Plans’ Early Response to Federal Parity Legislation for Mental Health and Addiction Services
Constance M. Horgan, Sc.D., Dominic Hodgkin, Ph.D., Maureen T. Stewart, Ph.D., Amity Quinn, Ph.D., Elizabeth L. Merrick, Ph.D., M.S.W., Sharon Reif, Ph.D., Deborah W. Garnick, Sc.D., Timothy B. Creedon, M.A.
2016, Volume 67, Issue 2, pp 162–168

Parity and Provider Networks
Alison Evans Cuellar, Ph.D.
2022, Volume 73, Issue 9, pp 961

The Effects of Federal Parity on Mental Health Services Use and Spending: Evidence From the Medical Expenditure Panel Survey
Coleman Drake, Ph.D., Susan H. Busch, Ph.D., Ezra Golberstein, Ph.D.
2019, Volume 70, Issue 4, pp 287–293

The Mental Health Parity and Addiction Equity Act (MHPAEA) Evaluation Study: Impact on Quantitative Treatment Limits
Amber Gayle Thalmayer, Ph.D., Sarah A. Friedman, M.S.P.H., Francisca Azocar, Ph.D., Jessica M. Harwood, M.S., Susan L. Ettner, Ph.D.
2017, Volume 68, Issue 5, pp 435–442

POPULATION-SPECIFIC IMPACTS OF PARITY LEGISLATION

Effects of Mental Health Parity on High Utilizers of Services: Pre-Post Evidence From a Large, Self-Insured Employer
Kyle L. Grazier, M.S., Ph.D., Daniel Eisenberg, Ph.D., Jenefer M. Jedele, M.Sc., Mary L. Smiley, M.S.
2016, Volume 67, Issue 4, pp 448–451

Mental Health Spending and Intensity of Service Use Among Individuals With Diagnoses of Eating Disorders Following Federal Parity
Haiden A. Huskamp, Ph.D., Hillary Samples, Ph.D., Scott E. Hadland, M.D., M.P.H., Emma E. McGinty, Ph.D., Teresa B. Gibson, Ph.D., Howard H. Goldman, M.D., Ph.D., Susan H. Busch, Ph.D., Elizabeth A. Stuart, Ph.D., Colleen L. Barry, Ph.D.
2018, Volume 69, Issue 2, pp 217–223

Quantifying Balance Billing for Out-of-Network Behavioral Health Care in Employer-Sponsored Insurance
Sarah A. Friedman, Ph.D., Haiyong Xu, Ph.D., Francisca Azocar, Ph.D., Susan L. Ettner, Ph.D.
2022, Volume 73, Issue 9, pp 1019–1026