Maryland Parity Project
The promise of healthcare reform means that millions of Americans may soon be able to access healthcare services formerly out of their financial reach. However, the implementation of that sweeping reform holds unprecedented challenges both across the nation and here in Maryland.
Take the following steps to know if you’re covered:
- Know the type of insurance you have – such as private commercial, self-insured, Medicaid or Medicare
- Check your benefits
- Discuss your coverage and parity changes with your mental health provider
- Contact us to learn more
What Does Parity Mean?
Parity simply means that people with mental health needs should have access to treatment services that are comparable to the physical health services they receive. In short, that mental health services are on par with somatic (physical) services.
Parity & Healthcare Reform
The intersection of healthcare reform with implementation of the nation’s federal mental health parity law is crucial to Marylanders with mental health needs. It impacts their ability to access inpatient and outpatient services, purchase medications, and obtain other treatment and support services.
Benefits vary depending on whether you have group, individual or other coverage. You need to know what type of coverage you have to know whether Maryland law or federal parity applies to you.
The federal parity law took effect in July 2010 and its provisions cover all insured individuals who receive commercial coverage through the Medicaid program or an employer with 50 or more employees. The remainder of the commercial insurance market will be covered in 2014 when health insurance care exchanges, which must comply with parity, are established.
How Does it Work?
The federal parity regulations set up 6 classes of health care benefits:
- inpatient in network
- inpatient out of network
- outpatient in network
- outpatient out of network
- emergency care
- prescription drugs
If insurers are providing medical/surgical benefits in any of these classes and they provide any mental health coverage, they must provide comparable benefits for mental health/substance abuse care in each of these 6 classes comparable to the range of services provided for somatic care. This means that a health plan’s definitions for inpatient, outpatient and emergency care must be applied uniformly for both behavioral health and somatic care. For example, if your health plan doesn’t routinely limit the number of times you can see your doctor for a physical health problem, then it cannot set a limit on how often you can see a mental health provider.
If you need help understanding your right to coverage, contact the Mental Health Association of Maryland at 410.235.1178 x206 or email us at email@example.com.
To learn more about mental health parity and healthcare reform, visit these sites:
- www.mentalhealthparity.org for more information on the federal parity law
- www.healthreform.maryland.gov for more information on healthcare reform in Maryland