WBT Flipbooks

Evaluating State Mental Health and Addiction Parity Statutes: A Technical Report 1 Executive Summary T he Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (the Federal Parity Law 1 ) requires insurers to treat illnesses of the brain, such as depression or substance use disorders, the same way they treat illnesses of the body, such as diabetes or cancer. In other words, large group health plans are required to cover mental health and substance use disorder (MH/SUD) care in a way that is no more restrictive than coverage for physical or other medical conditions. The Patient Protection and Affordable Care Act (ACA) expanded these requirements to small group and individual health plans by mandating behavioral health 2 services as an essential health benefit. The promise of parity remains elusive for many individuals directly impacted by mental illness or substance use disorders. They are denied care when they need it most and have few resources to advocate on their own behalf. Although federal and state governments share enforcement authority, states have a critical role in ensuring the Federal Parity Law and other state-related laws are properly enforced. States are primarily responsible for monitoring compliance with the Federal Parity Law for individual and fully-insured group plans. Despite the efforts of policymakers, advocates, and other stakeholders, major coverage and access disparities persist a decade later. Most states have not enacted strong state parity statutes, which would ensure that state regulators have a full set of tools to make parity a reality, in large part by holding both health plan executives and state officials accountable. Strong state parity laws are foundational to robust parity enforcement, because without such laws, there often is little transparency or accountability relating to health plans' parity compliance and regulatory agencies' enforcement activities. In advance of the 10th anniversary of the signing of the Federal Parity Law, we examined how states enact strong parity statutes in order to ensure that state regulators can fulfill the intent of the Federal Parity Law. This report is a result of research assessing the strength and quality of state statutes using a quantitative and systematic coding methodology that was applied to all 50 states. Based on input from experts in parity, the Statutory Coding Instrument (SCI) was developed to provide a quantitative, comparative assessment of state parity statutes. The SCI assigns points based on the inclusion of important statutory language in the state codes. Each state statute was assigned a letter grade based on the total points earned using the SCI (total possible score of 100). ________________ 1 "Law" refers to the entire body of statutory, administrative, and common law provisions that regulate our society. A "statute" is the specific, codified statement of a law that has been approved by the legislative body (and often endorsed by the executive body) of a government. 2 Behavioral Health is an all-encompassing term for both mental health and substance use disorders. This includes the full spectrum of conditions covered in the American Psychiatric Association's Diagnostic and Statistical Manual of Disorders (DSM). See the Glossary for a list of key terms/definitions used in this report (Appendix A)

• Cover