by Instacode Institute
April 5th, 2016
Historically, coverage of behavioral health services were very limited. If you were fortunate enough to have coverage for these types of services, they were generally paid at a lower rate than other medical benefits in your plan. Over the last decade, this disparity in coverage has changed - driven by legislative efforts. This began at the state level and over the last couple of years it has also expanded to the federal as well.
Providers need to understand that even though there are now federal laws, state laws are often different. It is important to ascertain patient coverage before treatment begins. See "Chapter 1.1 – Understanding Insurance Reimbursement" of the Behavioral Health DeskBook for a more thorough discussion about verifying coverage and different types of insurance plans.
There are 49 states and the district of Columbia which have their own mental health parity laws. Be aware of any special requirements for your state. Use the "50-State Table of Essential Health Benefits Benchmarks" tool to find out what is happening in your state.
Here are some federal laws which address mental health services:
- Patient Protection and Affordable Care Act (PPACA) is also known as healthcare reform or even ObamaCare. This law established essential healthcare benefits which include some mental health coverage.
- Mental Health Parity and Addiction Equity Act (MHPAEA): This law requires that insurance coverage of mental health conditions and substance use disorders be comparable to coverage of other medical conditions.
- Excellence in Mental Health Act of 2014
- State Laws Mandating or Regulating Mental Health Benefits - This excellent article by the National Conference of State Legislatures explains Mental Health "Parity" or Equal Coverage Laws, Minimum Mandated Mental Health Benefit Laws, and Mental Health "Mandated Offering Laws".
- Understanding Mandated Health Insurance Benefits
- Mental Health Parity and the Patient Protection and Affordable Care Act of 2010
- Implications for Coverage of Tobacco Cessation Benefits