The MHPAEA Federal Law: A Must Read for Parents
The Mental Health Parity and Addiction Equity Act (MHPAEA) was established in 2008. It is a federal law that protects individuals with disabilities by requiring commercial insurances to provide mental and behavioral health services without limitations outside of medical necessity. In other words, if an individual has a diagnosis, medical insurances must allow mental health and behavioral health providers to assign treatment — no exceptions.
It is also important to note that commercial plans cannot require an authorization or treatment plan before approval of services. They must insure services right away. Most providers do require an authorization and treatment plan prior to starting services as best practice, but it is not a requirement. This means that if there is a crisis, help can be provided right away.
Other quantitative benefits such as visit and day limits, and non-quantitive benefits such as medical management and step therapy cannot be restricted or limited. That is to say, the law prohibits private insurance plans from suggesting or modifying treatment prescribed, the location(s) where services are provided, hours recommended by provider, or how services are delivered.
Unfortunately, MHPAEA does not apply to Tricare, Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) because these plans are not commercial insurances. Yet, steps are being taken to address limitations within public health plans. Reaching out to your local government is one way to advocate for unified change.
If you suspect that you are not receiving the best services, whether through your current provider or through your current insurance, reach out to us at info@onebehavior.com or fill out our request form and please refer to the CMS website for more information.