Opioids Prescribing Practices Parity Legislation

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Prescribing Practices: Parity Legislation

The first Mental Health Parity Act (MHPA) legislation was signed into law in 1996 and took effect in 1998, championed by Senator Paul Wellstone.  MHPA requires annual or lifetime dollar limits on mental health benefits to be equal to such dollar limits for medical and surgical benefits offered by group health plans or payers.  Prior to MHPA, insurers were not required to cover mental health care.  The Mental Health Parity and Addiction Equity Act (MHPAEA) was signed in 2008 and took effect in 2010; the main purpose was to fill in the loopholes left by MHPA.  The MHPAEA requires health insurers as well as group health plans to guarantee that financial requirements on benefits for mental health or substance use are equal to the insurer’s requirements and restrictions for medical and surgical  benefits, including, but not limited to:

  • Co-pays
  • Deductibles
  • Inpatient or outpatient
  • In-network or out-of-network
  • Out-of-pocket maximums
  • Limitations on treatment benefits
  • Caps on visits with a provider
  • Days in a hospital visit
  • Prior authorization requirements
  • Fail-first policies

For example, the parity legislation was used to improve access to care for people with eating disorders.  Some insurers were covering as little as three visits for nutrition for an eating disorder, while visits for nutrition were unlimited for diabetes; this constitutes a parity violation. 
Advocates for parity pose the following questions:

  • If death from a certain type of cancer had quadrupled in the last 15 years, how would the resource allocation be different? 
  • If only 10% of people with a medical illness were getting treatment, what immediate changes would be made to increase the availability and access to care?

Advocates for parity point out the following considerations:

  • Consider a common medical illness, such as diabetes, and use the trajectory of care as an example for what to expect for mental or chemical health care
  • Does a person with diabetes need to have a controlled blood sugar or A1c in order to enter care?
  • Does a person with diabetes have a limit on the number of insulin needles they are provided?

The parity legislation promotes access to care for mental and chemical health.  To assess whether a parity violation has occurred, ask yourself: “Are limits for mental or chemical health care being applied more restrictively than other medical conditions?”  Another way to think about the parity legislation is: “Are mental and chemical health needs being treated with the same urgency as medical issues?” 

For more information, go to Parity Complaint Registry and Appeal Resource a national registry to track, study, and report on parity violations regarding the Mental Health Parity and Addiction Equity Act (MHPAEA).

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