Legislation always relies on a set of certain principles which guide it and serve as the foundation for future laws. One of the key principles used in the realm of health insurance coverage legislation is the idea of mental health parity. The concept of mental health parity ensures that people who have health insurance and face mental health problems are not discriminated against and have access to proper medical services.
The idea of mental health parity emerged as a response to the existing inequality in terms of the provision of healthcare. The existence of discrimination toward people with mental health conditions has been observed for a long period of time by experts and researchers (Sharma & Branscum, 2020). Health insurance plans, including both private ones and the Medicare program, had considerable barriers and limited access in the case of the services for individuals with mental and substance use disorders. The result of such limitations was greater out-of-pocket costs for people who had mental health illnesses and, in certain instances, the inability of such individuals to receive any professional assistance. Subsequently, in order to address the inequality in terms of the provision of mental and physical healthcare services, the concept of mental health parity was introduced. Thus, mental health parity refers to the idea that people with mental health issues must receive the same treatment from medical professionals and institutions as individuals with physical health problems.
Moreover, the majority of states and the federal government have adopted laws regarding benefits between mental health and general health services in health insurance. The most notable example of legislation concerning mental health parity is the Mental Health Parity and Addiction Equity Act (MHPAEA). The key idea behind the act was the introduction of official requirements for health plans to apply similar or the same rules to mental health disorder benefits as for physical health benefits (Sharma & Branscum, 2020). Specifically, the law ensures that most health plans offer parity for mental health benefits, including individual health insurance coverage and employer-sponsored group health plans. According to MHPAEA, the standard benefits which are subject to parity include annual visit limits, copayments, deductibles, proof of medical necessity, and the need for prior authorization. The principle of parity also affects the way a certain treatment is accessed and under which conditions treatment it is covered. Nevertheless, it is important to note that MHPAEA does not apply to all types of insurance.
There are several important rules which MHPAEA promotes and establishes as compulsory. For instance, cost-sharing and treatment limitations must be more restrictive than those applying to the majority of surgical and medical benefits. Additionally, Nonquantitative Treatment Limitations (NQTL) such as authorization policies should not affect people with mental health problems more stringently than people with physical issues. Since MHPAEA is a federal act, it applies nationwide, yet certain states have their own approaches to mental health parity. For example, several states limited parity laws requiring health plans to cover a minimum amount of mental health benefits (Sharma & Branscum, 2020). At the same time, whenever there is a conflict between the state and federal legislation, the latter takes precedence.
Mental health parity is a crucial principle in the sphere of healthcare and health insurance which guarantees the provision of proper medical services to people with mental health issues. Previously, individuals with mental health conditions were subject to considerable discrimination due to the fact that they faced limitations when receiving professional assistance and were denied certain benefits. Laws such as MHPAEA partially solved the problem and now guarantee a relative parity in terms of the provision of mental and physical health services.
Reference
Sharma, M., & Branscum, P. (2020). Foundations of mental health promotion (2nd ed.). Jones & Bartlett Learning.