The 2008 law extended mental health parity to group health plans providing mental health and substance use services, but did not require plans to provide these services. The ACA extended MHPAEA to apply to health plans in the individual market, also requiring that all individual and small group plans must provide mental health and substance use services. As a result, the mental health parity provisions in MHPAEA will apply to most commercial plans. The final rule does not address the application of mental health parity in Medicaid managed care plans, which will be done through future rule-making.
MHPAEA and its application to the individual and small group markets due to the ACA will increase access to a wider range of mental health and substance use services for individuals in those markets. In addition, these enrollees will have consistent cost-sharing across mental health or substance use and medical/surgical benefits. Other highlights include: The mental health parity provisions apply to group health plans and health insurers for plan years beginning after July 1, 2014. As a result, for policies beginning in January, the final rule will apply on January 1, 2015. In the meantime, plans must comply with the regulations from the Interim Final Rule.
- Separate deductibles for mental health and substance use services are not allowed.
- Tiered networks are allowed if medical/surgical and mental health or substance use services are treated equally.
- Multi-tier drug benefits are allowed if medical/surgical and mental health or substance use drugs are treated equally.
- Plans must classify intermediate mental health services similarly to medical/surgical services.
- Plans seeking exemptions from parity must provide actuarial certification of cost increases.