clinical social work association

September 11, 2024

Dear CSWA Members,

A notice about new Mental Health Parity rules to implement the long-standing Mental Health Parity and Equity Act (2008), which has been languishing since it was first enacted, was put out this week. The recent articles from ProPublica may have influenced the release of these rules at this time.

A review of the history of the MHPAEA can be found at https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity. The basic premise is that mental health treatment and substance use treatment be covered as fully as medical/surgical treatment. The primary areas where this applies include inpatient in-network; inpatient out-of-network; outpatient in-network; outpatient out-of-network; emergency; and prescription drugs. The problems in applying these reasonable standards is that there is no formula for what they should actually be, and reimbursement is not included in the areas that must be at parity for mental health treatment.

While any attempt to get insurers to cover mental health and substance use is worthwhile, until real enforcement is built into the rules – which is still not the case in the new rules – there will likely be little change to the ways that insurers currently limit coverage of mental health treatment.

Note that these new rules will go into effect in phases, with some being enacted in 2025 and some in 2026.

Please let me know if you have any questions.

Laura Groshong, LICSW, CSWA Director of Policy and Practice  
lwgroshong@clinicalsocialworkassociation.org