Medicaid Mental Health & Substance Use Disorder Parity

Medicaid Mental Health (MH) and Substance Use Disorder (SUD) Parity

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires health insurance carriers to achieve coverage parity between benefits for mental health/substance use disorders (MH/SUD) and medical/surgical benefits, especially with regard to financial requirements and treatment limitations. 

The Centers for Medicare and Medicaid Services (CMS) issued a final rule in March 2016  (the “Parity Rule”) to strengthen access to MH and SUD services provided through Medicaid health plans, Children’s Health Insurance Plans, and Alternative Benefit Plans. The Parity Rule requires these plans to ensure that they are not placing limits on access to MH or SUD services that are not applied to medical/surgical services. 

The Parity Rule required the Department of Health and Human Services (DHHS) to conduct a parity analysis for Calendar Year 2016. DHHS required its two Medicaid health plans, NH Healthy Families and Well Sense Health Plan, to conduct an analysis of  compliance with the Parity Rule for NH Medicaid behavioral health, substance use disorder, and medical/surgical service provided in four classification categories (Inpatient, Outpatient, Emergency and Prescription).  

Based on the information provided, and the DHHS determination that New Hampshire’s CHIP program, the Alternative Benefits Plan (APB) and the 1915c Home and Community Based waivers were in compliance with the relevant provisions of the Parity Rule, DHHS determined that the NH Medicaid Program was in compliance with the Parity Rule. As required by the Parity Rule, DHHS submitted its compliance report to CMS. The NH DHHS October 2, 2017 Parity Compliance Report includes the following appendices:

  • Appendix A: MCO Contract Parity Requirements – SFY 2018
  • Appendix B: NH DHHS Request for Parity Analysis (July 3, 2017)
  • Appendix C: NH DHHS Request for Parity Analysis: Classification Grid
  • Appendix D: NH DHHS Compliance Monitoring Plan (Final: October 2, 2017)

NH DHHS Parity Compliance Activities

Following the submission of the October 2, 2017 Compliance Report, DHHS began implementation of the NH DHHS Compliance Monitoring Plan. At the conclusion of the process, DHHS released a final parity compliance report for each Plan on December 31, 2018 covering CY 2016:

The purpose of the 2018 Plan Parity Reports is twofold: The first purpose is to fulfill DHHS responsibility to complete an independent review of the data and analysis submitted by each plan in order to validate both the parity analysis conducted by the Plan and the Plan’s conclusion that it was compliant with requirements of the Parity Rule for CY 2016. The second purpose is to identify any areas of concern to ongoing parity implementation and compliance by the Plans. The iterative process left only a limited number of questions related to the Inpatient and Outpatient Service Classifications. There were no outstanding parity questions related to the Emergency and Pharmacy Service Classifications.

NH DHHS Ongoing Parity Compliance Activities

Although the Parity Rule does not require ongoing parity reporting, DHHS has included parity compliance, analysis and reporting provisions in the Medicaid Care Management contracts between DHHS and the Medicaid health plans. 

This page is intended to provide information about NH’s Medicaid Program Parity Analysis process. Stakeholder feedback is invited and encouraged, as are questions about the Parity Analysis process. For questions or suggestions, email nhparity@dhhs.nh.gov