Health Insurance for Addiction & Mental Health Care: A Guide to the Federal Parity Law (June 2016)
This guide explains the right to health insurance coverage for substance use disorder and mental health care under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. It also briefly explains some other laws that impact coverage.
Red Flags! Your Health Plan May Be Violating the Law (2019)
This one-pager, also available in poster size, lists “red flags” that suggest a health insurance plan may be violating federal and state parity laws when denying or limiting access to substance use disorder or mental health care.
What To Do If You See a Red Flag (2019)
This tool, a companion to the “Red Flags!” tool, explains what health care providers, patients, and families should do if they see a “red flag” and think a health plan may be violating parity laws.
What NY Providers Can Do? (2019)
This handout explains how providers can advocate for their patients when an insurer refuses to reimburse mental health and/or substance use disorder care. Whether it’s filing an appeal or writing a letter of support, provider advocacy can go a long way in strengthening a patient’s appeal of an insurer’s denial . Learn more with this tool and share with other providers.
Summary of Parity Tracking Report: Key Findings and Recommendations to Improve Parity Enforcement
LAC, along with our partners in the Addiction Solutions Campaign, recently completed an in-depth analysis of publicly available documents for seven major health plans offered in 2015 and 2016 in the small and large group markets in New York and Maryland. This Executive Summary outlines the major findings and recommendations for improving the parity enforcement framework.
Frequently Asked Questions on the Federal Mental Health Parity and Addiction Equity Act (November 2013)
LAC has developed easy to read FAQs on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, also known as the federal parity law, which seeks to eliminate discriminatory access to mental health and substance use disorder benefits in certain health insurance plans. These FAQs were written after the Final Rule implementing the federal parity law was issued, and include information on the Final Rule.
Parity Sample Appeal Letters
LAC has drafted several sample appeals, complaints, and other letters for both patients and providers who think their rights under the parity law may have been violated. These samples can also be adapted for use by advocates, family members, and others.
Summary of Federal Mental Health Parity and Addiction Equity Act (October 2008)
A one-page summary of the major provisions of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, also known as the MHPAEA or the federal parity law. Note: The passage of the Affordable Care Act in 2010 expanded the reach of the MHPAEA, but the ACA expansion is not covered by this document.
Roadmap for Promoting Health and Justice: A Smarter, More Effective National Drug and Alcohol Policy
This landmark 2016 report from LAC’s Arthur Liman Policy Institute provides a comprehensive and detailed set of recommendations for improving our national drug and alcohol policies to improve health and public safety and save lives and resources.
Coalition for Whole Health Comments on Proposed Rule Applying Parity to Medicaid Managed Care, CHIP, and Alternative Benefit Plans
This Coalition for Whole Health document contains comments in response to the Department of Health and Human Services proposed rule implementing the MHPAEA to Medicaid Managed Care, CHIP, and Alternative Benefit Plans
Summary of the Proposed Rule Applying Parity to Medicaid Managed Care, CHIP, and Alternative Benefit Plans
A summary of the U.S. Department of Health and Human Services’ proposed rule applying the Mental Health Parity and Addiction Equity Act to Medicaid Managed Care Organizations, the Children’s Health Insurance Program (CHIP), and Alternative Benefit Plans.
Maintaining a Strong Safety Net: More Important Now than Ever
This one-page brief lays out the case for the continued necessity of providing robust funding for the federal Substance Abuse Prevention and Treatment block grant.
Funding Recommendations from the Field for FY 2016 Drug and Alcohol Prevention, Treatment, Recovery, and Research Programming
This table provides funding history and recommended funding levels for fiscal year 2016 drug and alcohol prevention, treatment, recovery, and research programming.
Summary of Interim Final Rule for Federal Mental Health Parity and Addiction Equity Act (February 2010)
A summary of the major provisions of the Interim Final Rule—a type of federal regulations—implementing the Mental Health Parity and Addiction Equity Act of 2008, also known as the MHPAEA or the federal parity law. Note: The Final Rule implementing the MHPAEA was issued in November 2013; please refer to Frequently Asked Questions on the Federal Mental Health Parity and Addiction Equity Act for more information on the Final Rule.
NYS Legislation to Address Opioid Crisis: Summary (July 2014)
A summary of the bills signed into law in New York State in June 2014 to address the state’s heroin and prescription opioid epidemic.
Coalition for Whole Health (Website)
For additional resources related to parity and insurance, please visit the Coalition for Whole Health website.
Coalition for Whole Health Comments to the Center for Consumer Information and Insurance Oversight (CCIIO) on guidance governing the state health insurance exchanges
This Coalition for Whole Health document contains comments in response to regulations governing the establishment of the state Health Insurance Exchanges created by the Affordable Care Act.
Coalition for Whole Health Comments to the Center for Consumer Information and Insurance Oversight (CCIIO) on guidance governing the federally facilitated exchanges
This Coalition for Whole Health document contains comments submitted to the Center for Consumer Information and Insurance Oversight at CMS on their bulletin on Federally-facilitated Exchanges.
Health Policy Reform: A Roadmap for Smarter and More Effective Alcohol and Drug Policies
This landmark report from Legal Action Center and the State Associations of Addiction Services makes specific and comprehensive recommendations to improve the national response to addiction.
The Medicaid IMD Exclusion: An Overview and Opportunities for Reform
This is a fact sheet on the Medicaid Institutions for Mental Diseases (IMD) exclusion that prohibits the use of federal Medicaid financing for care provided to most patients in mental health and substance use disorder residential treatment facilities larger than 16 beds. The exclusion is one of the very few examples of Medicaid law prohibiting the use of federal financial participation (FFP) for medically necessary care furnished by licensed medical professionals to enrollees based on the health care setting providing the services.
Coalition for Whole Health comments to the Centers for Medicare and Medicaid Services (CMS) on their proposed rule related to the Section 1915(i) Home and Community Based Services (HCBS) State plan option
This Coalition for Whole Health document contains comments to CMS on their proposed rule related to the Section 1915(i) Home and Community Based Services (HCBS) State plan option.
NY Attorney General Parity Enforcement
This page contains LAC’s summaries of the NY AG’s parity enforcement as well as the settlement agreements reached between the NY AG and various health insurers.
Accessing Insurance Coverage for Substance Use & Mental Health Treatment: The Federal Parity Law (October 2017)
This training provides an overview of the federal parity law and how individuals and providers can take advantage of their rights under the law.
Know Your Rights: New Federal “Parity” Legislation for Insurance Coverage of Addiction Treatment (June 2009)
This webinar provides an overview of the Paul Wellstone & Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
Strategic Stakeholder Convening on Early Identification and Intervention 9/27/2017
On September 27th, Legal Action Center, with generous support from the Conrad N. Hilton Foundation, held a Strategic Stakeholder Convening on Early Identification and Intervention: Preventing Adolescent Substance Use Problems.
Medication-Assisted Treatment (MAT) Advocacy Toolkit (2016)
This toolkit can help people fight for their right to medication-assisted treatment (MAT) for opioid addiction when courts, criminal justice and child welfare agencies, or employers do not allow it. MAT involves the use of medications, such as methadone, buprenorphine/naloxone (Suboxone) and injectable naltrexone (Vivitrol), in combination with counseling. Dozens of studies have shown that MAT reduces illicit drug use, crime, and communicable disease. The toolkit also includes resources for attorneys and other advocates.
Toolkit on Essential Health Benefits, Parity, and Network Adequacy
This Coalition for Whole Health toolkit provides advocates with materials to advocate for strong implementation and oversight of the ACA’s essential health benefits, parity, and network adequacy protections.
Template Language for Advocating to Improve Health Insurance Coverage of Substance Use Services in Your Plan
Provides template language developed by the Coalition for Whole Health for individuals who are advocating for better coverage of substance use and mental health services in their health insurance plan, especially helping people protect their rights under the federal Mental Health Parity and Addiction Equity Act.