The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law about access to mental health (MH) and substance use disorder (SUD) services.
Ensuring parity means that accessing MH and SUD services are equitable and not more difficult to access than physical health services.
Parity rules impact service equity in the following categories:
- Visit, annual, and lifetime limitations
- Financial and cost sharing requirements
- Prior authorization requirements
Parity also allows you to request and review the criteria used to determine when a service or treatment is medically necessary. You may contact your plan administrator to request criteria information.
If a MH or SUD service request is partially approved or denied, you will be sent a letter explaining why the service could not be approved. The letter will also explain your right to appeal the decision and the process to request an appeal.
It is important to note that the law does not require insurance and Medicaid plans to cover MH and SUD services, but when a service is covered, the service is subject to the MHPAEA rules.
Medicaid Benefit Plans
Outpatient behavioral health benefits provided under the Idaho Behavioral Health Plan (IBHP) are administered by OPTUM Idaho.
Inpatient benefits are administered by Telligen and the Idaho Division of Medicaid.
Medicare-Medicaid Coordinated Plan
Blue Cross of Idaho administers benefits for participants receiving benefits through the True Blue Special Needs Plan.