Harrisburg, PA – In honor of Mental Health Awareness Month, Pennsylvania Acting Insurance Commissioner Michael Humphreys announced the Department is taking immediate action to examine and identify insurance companies across the Commonwealth for areas of non-compliance as it pertains to mental health parity laws. The Commissioner is reminding consumers and providers that Pennsylvania law requires equivalent coverage of mental health and substance use disorder treatment as for medical or surgical services. Governor Josh Shapiro has made mental health and substance use disorder treatment parity a priority in his administration, and the Pennsylvania Insurance Department (PID) is committed to making treatment parity a reality in the commonwealth.
In his Budget Address, Governor Shapiro voiced concern over the effective enforcement and compliance of mental health parity laws in this country. The Governor has directed Commissioner Humphreys to make mental health parity a true reality here in Pennsylvania.
"Governor Shapiro knows that mental health parity laws are critical protections for consumers. Under his direction the Insurance Department is holding insurers accountable so that benefits are covered fairly," said Humphreys. "To that end, the Department has examined companies for compliance, identified areas of non-compliance, and provided tools to help companies fully realize consumers' parity rights. The companies have everything they need to provide mental health and substance abuse benefits at parity, and we expect to see significant improvement as we begin re-auditing companies and as 2024 policy forms are submitted later this month. The Department will do everything in its statutory authority to protect consumers' parity rights and access to necessary treatment."
PID is highlighting the importance of understanding parity in insurance coverage and proper implementation of parity requirements throughout the month of May, which is recognized nationally as Mental Health Awareness Month.
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires most health insurance plans that provide coverage for mental health and substance use disorders to offer an equivalent level of coverage for mental health and substance use disorders as for medical or surgical care. Parity is required in areas such as quantitative limitations, including:
- What consumers pay, in terms of copays, coinsurance, deductibles, and out-of-pocket maximums
- How much treatment individuals can get, such as limits on the number of inpatient or outpatient visits that are covered
and non-quantitative limitations, such as:
- Which doctors patients see and whether services by out-of-network providers are covered
- The criteria insurance companies use to determine what is considered medically necessary treatment
- The use of management tools, such as requiring prior authorization.
Mental health and substance use disorder coverage parity is required under both federal and state law. PID oversees compliance in the fully insured, individual, and group markets. Other regulators monitor parity compliance by self-funded plans, as well as by government programs. PID currently reviews all individual, small, and large group health insurance plans for parity compliance.
Violations of parity laws take many forms, but they generally involve restrictions on mental health and substance use disorder services that do not apply to medical or surgical services, or stricter requirements to approve and receive mental health and substance use disorder treatments. For example, not covering out-of-network behavioral health services but covering out-of-network services for physical conditions.
Humphreys urged consumers and providers to contact the department if they think a health plan is not meeting parity requirements for mental health and substance use disorder coverage or if a consumer has questions about the benefits to which they are entitled.
"Even if a plan isn't under PID's jurisdiction, we want to help consumers by connecting them with the appropriate agency to manage any parity issues they may be experiencing," said Humphreys. "We're here to be a resource for consumers and bringing issues to our attention can help us to address areas where parity is not being implemented correctly."
For more information on the mental health and substance use disorder parity, or to file a complaint or ask a question, visit the department's Bureau of Consumer Services at www.insurance.pa.gov/consumers or call 1-877-881-6388.