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Evaluating State Mental Health and Addiction Parity Statutes: A Technical Report 5 State and Federal Shared Responsibility W ith a few notable exceptions, 3 most insurance plans are covered in some way by parity laws. Enforcement responsibilities under the Federal Parity Law vary based on the type of insurance plan. While the federal government provides overall direction on parity enforcement activities, states are primarily responsible for monitoring compliance for fully- insured group plans, individual and employer-funded plans of less than 51insured employees, Medicaid managed care organizations (MCOs), the Children's Health Insurance Program (CHIP), and in states that have expanded Medicaid under the ACA, to Alternative Benefit Plans. The federal government has "backup" jurisdiction in states that assert they cannot enforce or fail to substantially enforce the Federal Parity Law. 4 An estimated 26.6% of the U.S. Population or 87 million Americans are impacted directly by state insurance regulators. 5,6 Within the federal government, enforcement is split among three different agencies depending on the type of health plan at issue. The US Department of Health and Human Services (HHS) oversees and has enforcement authority over the group and individual market as well as Qualified Health Plans in the exchanges. The US. Department of Labor (DOL) and the Internal Revenue Service (IRS) generally have enforcement authority over self-insured private sector employment-based plans that are subject to the Employee Retirement Income Security Act (ERISA). In addition, the Office of Personnel Management is responsible for ensuring that the Federal Employees Health Benefit Program plans comply with parity. ________________ 3 Health insurance plans for which the Federal Parity Law does NOT apply include: Small employer plans created before March 23, 2010 (these were "grandfathered," and therefore exempt from the requirements of parity), plans sponsored by religious institutions and self-insured plans sponsored by state and local governments, retiree-only plans, TriCare, Medicare, Traditional Medicaid (fee for service, non-managed care). While states are prohibited from regulating some plans that are not covered by the Federal Parity Law (e.g. Medicare and TriCare), other plans (e.g. small employer plans and self-funded non-federal governmental plans), may be subject to parity protections by state law. 4 Alabama, Oklahoma, Missouri, Texas and Wyoming have asserted that their state insurance commissioner lacks the authority under the current state laws to enforce the Federal Parity Law (Source: SAMHSA.gov) 5 Henry J. Kaiser Family Foundation. (2016). Health Insurance Coverage of the Total Population. [Data file]. Retrieved from https://www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location %22,%22sort%22:%22asc%22%7D 6 Henry J. Kaiser Family Foundation. (2016). Figure 10.1. Percentage of Covered Workers in a Self-Funded Plan, by Firm Size. Retrieved from https://www.kff.org/report-section/ehbs-2017-section-10-plan-funding/#figure101

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