MCG and Support for Mental Health Parity

MCG Physician Editor for Behavioral Health, João Ramos, MD, is a Board-certified psychiatrist and member of the American Psychiatric Association. In this video, he discusses how MCG Behavioral Health Care guidelines are developed to align with the principles of mental health parity. He also explains how MCG can support care providers, health plans, and government agencies to achieve parity compliance. Learn more: www.mcg.com/ca...
From CMS: The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as amended by the Affordable Care Act, generally requires that group health plans and health insurance issuers offering group or individual health insurance coverage ensure that the financial requirements and treatment limitations on Mental Health or Substance Use Disorder (MH/SUD) benefits they provide are no more restrictive than those on medical or surgical (med/surg) benefits. This is commonly referred to as providing MH/SUD benefits in parity with med/surg benefits.
There are requirements for determining parity with respect to financial requirements (such as copays) and for treatment limitations, which limit the scope or duration of benefits for treatment. Treatment limitations may be quantitative treatment limitations (QTLs) which are numerical in nature (such as visit limits) or non-quantitative treatment limitations (NQTLs), which are non-numerical limits on the scope or duration of benefits for treatment (such as preauthorization requirements).2 The rules for financial requirements and QTLs are different from the rules for NQTLs. This publication focuses on NQTLs and how to identify provisions that will require inquiry beyond the plan/policy terms in order to determine compliance with mental health parity requirements.