Mental Health Parity and
Addiction Equity Act
(MHPAEA)
Access to Tobacco Cessation Services
May 19-20, 2014
Warren Ortland
Staff Attorney
Tobacco Control Legal Consortium
The Tobacco Control Legal
Consortium
A national legal network
supporting tobacco control policy
change.
Tobacco Law Centers
Minnesota
New York
Michigan
Massachusetts
California
Maryland
Who We Serve:
• Public health advocacy organizations and
community coalitions
• Public health officials
• Elected officials
• City and county attorneys
• Private attorneys and individual
citizens
What We Do:
• Policy development
• Litigation support
• Legal research, analysis, and
interpretation
• Education and training
Paul Wellstone & Pete Domenici Mental
Health Parity and Addiction Equity Act
of 2008 (MHPAEA)
Mental Health Parity Legislation
• Mental Health Parity Act (1996)
• Mental Health Parity and
Addiction Equity Act (2008)
• MHPAEA Interim Final Rule
(2010)
• Patient Protection and
Affordable Care Act (ACA)
(2010)
• MHPAEA Final Rule (2013)
Mental Health Parity
Does not require that coverage be offered for any
particular mental health condition or substance use
disorder
Essential Health Benefits (10 categories)
Mental Health and Substance Use Disorders Service
Nicotine Addiction
Mental Health Parity
Requires certain medical plans that cover mental
health or substance use disorders to offer coverage
for those services that is similar to coverage for
medical / surgical benefits
Mental Health Parity
“Comparable to” & “No more restrictive than”
1. Is the limitation applied to substantially all
medical/surgical benefits
2. Is it the predominant treatment limitation
3. Is it more restrictive for MH/SUD benefits
than for medical/surgical
Mental Health Parity
“Comparable to” & “No more restrictive than”
• Example:
– A plan has a “prior authorization” requirement
for MH/SUD, but not for medical / surgical
benefit
– The plan violates the MHPAEA because the
offering of MH/SUD services cannot be more
restrictive than those for medical / surgical
Mental Health Parity
Six Classifications used to apply law
1. Inpatient, in-network
2. Inpatient, out-of-network
3. Outpatient, in-network
4. Outpatient, out-of-network
5. Emergency care
6. Prescription drugs
Mental Health Parity
Parity within and across classifications
Inpatient, in-network
Medical/Surgical
MH/SUD
Outpatient, out-of-network
MH/SUD
MHPAEA Tobacco Cessation
Treatment for nicotine addiction does not
have to be offered in a plan, but if offered:
• Should be offered across all plan
classifications
• Limitations for nicotine addiction
treatment should be comparable to those
for medical / surgical conditions
Mental Health Parity
Quantitative / Non-quantitative limitations
Quantitative
• Frequency of treatment
• Number of visits
• Days of coverage
Non-quantitative
• Medical management standards
• Formulary design
• Determination of usual/customary/reasonable
MHPAEA – Plans Covered
• Employer funded 50+ employees
• Non-grandfather employer
funded plans with 50 or fewer
employees
• Medicaid managed-care plans
• Children’s Health Insurance
Plans
• Medicaid Alternative Benefits
Plans
MHPAEA – Plans NOT Covered
• Small employer plans created
before 2010
• Church-sponsored plans
• Self-insured plans for state
and local government
• Retiree-only plans
• TriCare
• Medicare
• Traditional Medicaid
X
MHPAEA Impact
• Between 2007 and 2011, mental
health and substance use
admissions increased
• Per capita spending on these
admissions increased faster
than spending on medical
surgical
• Role of MHPAEA on this trend is
not clear because of other
possible contributing factors
MHPAEA Implementation Dates
•
New regulations effective
Jan. 13, 2014
•
Mental health parity
provisions of final rule apply
to plan years beginning on or
after July 1, 2014.
•
In interim, plans adhere to
provisions of interim final rule.
MHPAEA Enforcement
General Questions and Comments
•
Department of Health and Human
Services; Centers for Medicare and
Medicaid Services
Health Insurance Helpline
1-877-267-2323
Email CMS Helpline:
phig@cms.hhs.gov
•
Department of Labor
1-866-444-3272
MHPAEA / Cessation Resources
The Mental Health Parity and Addiction Equity Act and the
Affordable Care Act: Implications for Coverage of Tobacco
Cessation http://www.publichealthlawcenter.org/sites/default/files/resourc
es/tclc-fs-mhpaea-&-aca-2014_0.pdf
The Mental Health Parity and Addiction Equity Act: Key
Elements and Implications for Smoking Cessation Therapies http://www.ttac.org/tcn/peers/pdfs/10.26.10B/SD_VCP01540_MHPAEA_White_Paper_Long.pdf
Contacts
Tobacco Control Legal Consortium
www.tclconline.org
Maggie Mahoney
(651) 290-7514
maggie.mahoney@wmitchell.edu
Public Health Law Center
www.publichealthlawcenter.org
Warren Ortland
(651) 290-7539
warren.ortland@wmitchell.edu