Parity

Patients need your help to enforce mental health parity! 

With all the recent discussion of the future of the Affordable Care Act (ACA), members have asked about the impact of the ACA’s destiny on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). MHPAEA is a separate statute that applies to large group employer plans (+50 people), Medicaid managed care arrangements and nonfederal government plans that do not opt out. The ACA expanded MHPAEA to Medicaid expansion plans, Exchange Plans and to the individual and small group markets. Right now, MHPAEA impacts almost all insurance products on the market, and your patients need your help in dealing with possible parity issues and ensuring access to care. What can you do? Please click here for step by step directions and helpful websites.

  • Help patients understand their rights under the federal mental health parity law by making this flyer available in your office.
  • SAMHSA has a tri-fold brochure that can be distributed in waiting areas to alert patients to their rights and protections under the parity law.

Report Parity Violations

The Parity Track website has a place to register complaints about health plans’ denial or restriction of care.  Parity Track partners include the Kennedy Forum and the Scattergood Foundation; its coalition also includes Mental Health America, NAMI and others.

For assistance with parity complaints:

Colleen Coyle, APA General Counsel, can help assess possible parity violations

Sam Muszynski, APA Director of Parity Enforcement, is another resource (call 703-907-8594).

You can also FAX information below to Maureen Bailey at APA – 703-907-1089

  1. Name of patient’s insurance company
  2. Source of the insurance for the patient (Medicare, exchange plan, employer plan and if so, name of employer if you know it)
  3. Name of the pharmacy benefit company
  4. Drug requiring pre cert
  5. Time you spent trying to get the prior authorization
  6. Any impact on the patient while waiting.

Or, contact the Maryland Parity Project at 443-901-1550.