The Mental Health Parity and Addiction Equity Act

Congress enacted the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008.  MHPAEA requires health care service plans that provide mental health and substance use disorder (MH/SUD) benefits to provide those benefits at the same level as the Plan’s medical/surgical benefits. The MHPAEA does not require a plan to offer MH/SUD benefits, but if the plan does so, it must offer the benefits on par with the medical/surgical benefits it covers.

Most plan benefits are subject to financial requirements, such as copays, coinsurance, and deductibles, and to treatment limitations, such as needing to obtain plan approval before you receive treatment.  Under MHPAEA, health plans must ensure that financial requirements and treatment limitations that apply to MH/SUD benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.

About DMHC MHPAEA Compliance Filings

The federal government authorized states to enforce plan compliance with MHPAEA.  The DMHC ensures plan compliance with MHPAEA in commercial coverage for individuals, small groups, and large groups.  The DMHC requires newly licensed full-service health plans that offer commercial coverage to submit filings that demonstrate their compliance with MHPAEA.  Licensed full-service plans previously reviewed for MHPAEA compliance may need to submit another compliance filing if they begin offering commercial coverage in a new market, add EPO or PPO coverage to their previously approved HMO coverage, change their behavioral health plan, or make other significant changes to their license.

Each full-service commercial health plan is responsible for ensuring compliance with MHPAEA, whether MH/SUD services are provided directly by the plan, carved out to a behavioral health plan, or delegated to a provider entity.

Health plans are required to submit to the DMHC detailed information on how the financial requirements, quantitative treatment limitations, and non-quantitative treatment limitations in their benefit plan designs comply with MHPAEA.

Health plans needing assistance with what they must submit to the DMHC in a MHPAEA compliance filing should contact the Office of Plan Licensing (OPL) at 916-324-9046.  OPL personnel will provide the plan with information, including:

  • Instructions for the compliance filing that are customized for newly licensed plans or for currently licensed plans making a significant change to their license
  • MHPAEA filing worksheets that assist plans with classifying benefits and calculating financial requirements (FRs) and quantitative treatment limits (QTLs):
    • Table 1:  Financial Requirements – Deductibles
    • Table 2:  Financial Requirements – Out-of-Pocket Maximums
    • Table 3:  Financial Requirements – Copayments and Coinsurance
    • Table 4:  Quantitative Treatment Limits
    • FR and QTL Workbook
  • MHPAEA Table 5:  Non-Quantitative Treatment Limitations

Plans may access many of the MHPAEA filing documents listed above and other information about MHPAEA compliance through the DMHC’s eFiling webportal, by clicking the "Downloads" link to locate the "MHPAEA" folder.