263 Enforcing Mental Health Parity 2015
parity occurred in the early 2000s, but none resulted in new law.86
In 2008, Congress passed a parity law with some teeth—the MHPAEA.87
This was followed by the introduction of the ACA in 2010, which dramatically overhauls much of the American health insurance coverage land-
scape.88 The following sections discuss the enforcement provisions of the
MHPAEA and ACA.
B. Enforcement under MHPAEA
The purpose of the MHPAEA was to eliminate the differences in insurance coverage for MH and SU benefits.89 The law requires group health
plans and health insurance issuers to offer parity between MH and SU disorder benefits, and medical/surgical benefits with respect to financial requirements and treatment limitations.90 The MHPAEA also amends the
Employee Retirement Income Security Act of 1974 (“ERISA”), the PHSA,
and the Internal Revenue Code.91
The MHPAEA expands the prohibition on the use of special annual and
lifetime dollar limits—originally only in place for MH benefits—to include
SU benefits.92 Although the MHPAEA affords new protections to group
health plan participants, the parity law does not mandate that a plan provide
MH and SU benefits.93 Rather, if a plan provides medical/surgical and MH
and SU benefits, only then must the provider comply with the MHPAEA’s
parity mandate.94 The MHPAEA also adds new disclosure provisions for
group health plans and group health insurance issuers, mandating that
“medical necessity” determinations and the reason for denial of payment for
services, with respect to MH/SU benefits, be disclosed to the plan partici-cost sharing, and the application of managed care techniques that continued to make coverage for mental health benefits less generous than coverage for other health benefit”).
86. Kessler, supra note 19, at 155 (discussing the Mental Health Equitable Treatment
Acts of 2001, 2002, and 2003 and noting that none of these acts were ever passed and signed
87. MHPAEA, 29 U.S. C. A. § 1185(a) (West, WestlawNext current through P.L. 113-
88. See generally ACA, Pub L. No. 111-148, 124 Stat.119 (2010) (codified as amended
in scattered sections of U.S. C.).
89. Barry et al., supra note 9, at 404.
90. MHPAEA, 29 U.S. C. A. § 1185(a); See also U.S. Dep’t of Labor, Mental Health
Parity Act and Addiction Equity of 2008 Fact Sheet (MHPAEA) (Jan. 29, 2010),
91. HILDA SOLIS, U.S. DEP’T OF LABOR, REPORT TO CONGRESS: COMPLIANCE WITH THE
MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 4 (2012), available at
http://www.dol.gov/ebsa/pdf/mhpaeareporttocongress2012.pdf (citing ERISA § 712; PHSA
§ 2726; and IRS Code § 9812).
92. Id. at 7.
93. See Mental Health Parity and Addiction Equity Act of 2008 Fact Sheet, supra note
90, at 1.
94. See, e.g., Barry et al., supra note 9, at 406–07.