On June 4, 2014, the New York State Department of Financial Services circulated this letter to provide guidance to insurers about the impact of Mental Health Parity and Addiction Equity Act (MHPAEA) on the state marketplace plans and how to be in compliance with MHPAEA. The letter provides a brief summary of the background of the law that was enacted in 2008. It also details how benefits should be classified, and how both [tippy title=”quantitative” header=”on”] A limitation on treatment that can be expressed in numbers. Examples include: visit limitations, inpatient day limitations, and co-insurance requirements such as co-payments.[/tippy] and [tippy title=”nonquantitative treatment limitation” header=”on”] A limitation that cannot be expressed numerically. These are cost containment strategies, often referred to as care management, includes requirements such as prior authorization, step-therapy, prescription drug formulary creation, utilization review, etc.[/tippy] must comply with the law.
MHPAEA does not require plans to cover mental health and substance abuse disorder; rather, it makes sure that plans that already offers mental health and substance use disorder (MH/SUD) coverage do so at the same level of coverage under the plan for surgical and medical conditions. In 2013, President Barack Obama signed the Affordable Care Act into law which requires participating individual and small group health plans to provide mental health and substance use disorder benefits in compliance with MHPAEA as an essential health benefit.
For more information on MHPAEA check out the Know Your Rights page. Contact us if you have any questions or believe a Maryland insurer may be in violation of MHPAEA.