Mental Health Parity: Overview

Practical Law Practice Note 2-594-2645 (Approx. 41 pages)

Mental Health Parity: Overview

by Practical Law Employee Benefits & Executive Compensation
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A Practice Note addressing requirements under the Mental Health Parity and Addiction Equity Act (MHPAEA) for group health plans and health insurers that provide both M/S (M/S) benefits and mental health benefits/substance use disorder (MH/SUD) benefits.

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Resource ID 2-594-2645
Copyright © Thomson Reuters Canada Limited or its licensors. All rights reserved.
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Resource Type Practice notes
Jurisdiction
  • USA (National/Federal)
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Table of Contents
  1. 1Affordable Care Act, 21st Century Cures Act, CAA-21, and 2013 Regulations
    1. Applicability of 2013 Tri-Agency Regulations
    2. Limits on Scope of 2013 Regulations
    3. Single Plan Rule
    4. Opt-Out for Non-Federal Governmental Plans (Eliminated by 2022 Legislation)
    5. 21st Century Cures Act and Subsequent Guidance
    6. Final FAQs (Sept. 2019) Include Claims Form for Requesting Plan Documents
    7. TRICARE Final Rules Addressing Mental Health and Substance Use Disorder Benefits
    8. ACA External Review
    9. Consolidated Appropriations Act, 2021 (CAA-21)
  2. 2DOL Enforcement of MHPAEA and Implementing Regulations
    1. Enforcement for 2021 (Issued Feb. 2022); 2022 Report to Congress
    2. Enforcement for 2020 (Issued Jan. 2021)
    3. Enforcement for 2019 (Issued March 2020); 2020 Report to Congress
    4. Enforcement for 2018 (Issued Sept. 2019)
    5. Enforcement for 2017 (Issued Apr. 2018)
    6. Enforcement for 2016 (Issued Feb. 2017)
  3. 3Self-Compliance Tool
    1. Self-Compliance Tool Is Periodically Updated
  4. 4Framework for Federal Mental Health Parity (MHPAEA) Analysis
  5. 5Frequency of Parity Analysis
  6. 6Private Right of Action Available
  7. 7MHPAEA Terminology
    1. Medical and Surgical Benefits
    2. Mental Health or Substance Use Disorder Benefits
    3. Treatment Limitations
  8. 8Parity Analysis for Aggregate Lifetime and Annual Dollar Limits
    1. Plans With No Limits or Limits on Less Than One-Third of M/S Benefits
    2. Plans With No Limits or Limits on at Least Two-Thirds of M/S Benefits
    3. Determining One-Third and Two-Thirds M/S Benefits Amounts
    4. Default Category
  9. 9Parity Analysis Regarding Financial Requirements and Treatment Limitations
    1. Six Classifications of Benefits
    2. Key Concepts: Types, Predominant, and Substantially All
    3. Cumulative Financial Requirements or Quantitative Treatment Limitations Prohibited
    4. Interaction with ACA's Preventive Health Services Requirements
    5. Parity Analysis and Items and Services Required Under COVID-19 Legislation
    6. Rules for Special Contexts
  10. 10Examples Involving Financial Requirements and Quantitative Treatment Limitations
    1. Example 1: Separate Financial Requirements in a Classification
    2. Example 2: Separate Financial Requirements in a Classification
    3. Example 3: Different Deductibles for Different Coverage Units
    4. Example 4: Prescription Drug Benefits
    5. Example 5: Permissible Subclassifications for Provider Networks
    6. Example 6: Permissible Subclassifications for Outpatient Visits
  11. 11Parity Analysis and Abortion-Related Travel Benefits (Post-Dobbs)
  12. 12Form for Requesting Information About Treatment Limitations