MEMORANDUM

To: Member of Congress

From: (your name)

Topic: Mental health insurance parity

Date: March 15, 2017

Mental health parity describes the equal treatment of psychological state conditions and
substance use disorders in insurance plans. Once an idea has parity, it means if you're provided
unlimited doctor visits for a chronic condition like polygenic disorder then they have to provide
unlimited visits for a psychological state condition like depression or schizophrenic disorder.
However, parity does not imply that you just can get smart psychological state coverage.
Comprehensive parity needs equal coverage, not essentially "good" coverage. If the insurance
arrange is incredibly restricted, then psychological state coverage are going to be equally
restricted even in an exceedingly state with a powerful parity law or in an exceedingly arrange
that's subject to federal parity.

In 2008, Congress passed the Paul Wellstone and Pete Domenici psychological state Parity and
Addiction Equity Act (MHPAEA) to confirm equal coverage of treatment for mental disease and
addiction. In November 2013, the national discharged rules to implement the law. Before this
law, psychological state treatment was usually coated at so much lower levels in insurance
policies than physical unwellness. If the health insurance plan is very limited, then mental health
coverage will be similarly limited even in a state with a strong parity law or in a plan that is
subject to federal parity.

Following are plans that must follow by federal parity:

Group health plans for employers with 51 or a lot of staff.

Most cluster health plans for employers with fifty or fewer staff unless they need been
grandfathered," which implies it absolutely was created before the federal parity laws
went into result.
The Federal staff Health advantages Program.
Health care Managed Care Plans (MCOs).
State Childrens insurance Programs (S-CHIP).
Some state and native government health plans.
 Any health plans purchased through the insurance Marketplaces.
Most individual and cluster health plans purchased outside the insurance Marketplaces
unless grandfathered.

If a state encompasses a stronger state parity law, then insurance plans regulated in this state
should follow those laws. For instance, if state law needs plans to hide psychological state
conditions, then they have to do thus, even supposing federal parity makes inclusion of any
psychological state advantages facultative. Federal parity replaces state law solely in cases
wherever the state law prevents the application of federal parity needs. for instance, if a state
law needs some coverage for psychological state conditions, then the federal demand of equal
coverage can trump the weaker state law.

Benefits and Services That Must Be Covered Equally are given below:

If a plan has to follow federal parity law, then the following must be covered equally when it
comes to treatment limits and payment amounts.

Inpatient in-network and out-of-network

Outpatient in-network and out-of-network

Intensive outpatient services

Partial hospitalization

Residential treatment

Emergency care

Prescription drugs

Co-pays

Deductibles
 Maximum out-of-pocket limits

Geographic location

Facility type

Provider reimbursement rates

Clinical criteria used to approve or deny care

Federal parity additionally applies to clinical criteria utilized by health insurers to approve or
deny psychological state or substance use treatment. the quality for medical necessity
determinations whether or not the treatment or provides square measure thought of by the health
decide to be cheap, necessary, and/or applicable should be created offered to any current or
potential health arrange member upon request. The rationale for denials of coverage should even
be created offered upon request.

Following are the some Signs a Health Plan May Be Violating Parity Requirements:-

Higher prices or fewer visits for psychological state services than for different kinds of
health care.
Having to decision and acquire permission to urge psychological state care lined,
however not for different kinds of health care.
Obtaining denied psychological state services as a result of they weren't thought of
medically necessary, however the arrange doesn't answer missive of invitation for the
medical necessity criteria they use.
Inability to seek out any in-network psychological state suppliers that square measure
taking new patients however will for different health care.
The plan will not cover residential mental health or substance use treatment or intensive
outpatient care, but they do for other health conditions.

If you think that your arrange has desecrated parity necessities, you'll speak together with your
arrange. The rationale for denials of coverage should be created offered by your insurer upon
request. If your treatment is denied and you disagree, you must contact your plan's client
relations division promptly. Youll file a written formal charm (ask your plan for details) or use
NAMI's guide letters if your informal makes an attempt aren't productive.

Best,

(Your name)

References:

https://www.thekennedyforum.org/parity
http://www.npr.org/sections/health-shots/2016/10/31/500056803/federal-panel-calls-for-
stricter-enforcement-of-mental-health-care-parity-law
http://www.nami.org/Find-Support/Living-with-a-Mental-Health-
Condition/Understanding-Health-Insurance/What-is-Mental-Health-Parity
https://en.wikipedia.org/wiki/Mental_Health_Parity_Act
https://www.samhsa.gov/health-financing/implementation-mental-health-parity-
addiction-equity-act