Figure 1: Evolution of Federal Mental Health Parity
|Definition of behavioral health
|Plans define what is considered behavioral health versus medical care.
|State Medicaid agencies can define what is behavioral health versus medical care. MCOs, PHIPs and PAHPs must follow the state’s definition.
|Long term care services
|Long term care services are considered “excepted benefits” that do not have to comply with parity.
|Long term care services generally must meet parity standards.
|Plans must evaluate parity for out-of-network inpatient care and out-of-network outpatient care.
|The two out-of-network classifications do not apply to Medicaid MHPAEA.
|Plans can determine parity separately for each provider network tier in a classification.
|Medicaid parity regulations do not give Medicaid plans with network tiers the ability to evaluate parity within each tier. Parity is evaluated for all care within a classification.
|Cumulative Quantitative Treatment Limits
|Quantitative treatment limits (such as a limit on the number of visits for a service per year) cannot accumulate separately for behavioral health and medical.
|Quantitative treatment limits can accumulate separately for behavioral and medical services if certain standards are met.
|Disclosure of reasons for denial of a claim
|Plans subject to ERISA must provide the denial reason in the form/manner included in ERISA claims review rules that are separate from commercial parity rules. NonERISA plans that follow this form and manner are deemed to comply with this parity requirement.
|Medicaid is subject to its own form/manner notice standards for providing the reason for a claim denial in adverse action notice regulations that are separate from Medicaid parity rules.
|Plans can qualify for a temporary exemption from meeting the MHPAEA standards if they meet certain requirements for cost increases.
|Medicaid regulations do not apply the cost exemption to Medicaid.
|SOURCE: 70 Federal Register 68240-68296; 80 Federal Register 18390-18445
Figure 2: Steps in NQTL Comparative Analysis