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Mental Health and Substance Abuse Parity


1. CMS issued the Medicaid managed care final rule in May of 2016 which recognizes that managed care plans have flexibility in ensuring access and availability of covered services including short-term inpatient psychiatric and SUD treatment.

A. True

B. False

2. The steps taken toward parity implementation provide direct protections that are indirectly important for everyone, since over the course of their lifetimes, Americans face a _____ chance of needing behavioral health services.

A. 90%

B. 70%

C. 50%

D. 30%

3. Without effective treatment, people with mental health and substance abuse conditions may:

A. Find it difficult to find or maintain a job.

B. Be less able to pursue education and training opportunities.

C. Be more likely to have their housing stability threatened.

D. All of the above.

Establishing the Parity Task Force

4. The president’s memorandum directs the White House Domestic Policy Council, the Departments of Treasury, Defense, Justice, Labor, Health and Human Services, and Veterans’ Affairs and the Offices of Personnel Management and National Drug Control Policy, to review parity implementation and do all of the following, except for:

A. Increase awareness of the protections that parity provides.

B. Enforce activities at the state level by providing trainings and technical assistance and responding to inquiries.

C. Improve understanding of the requirements of parity and of its protections among key stakeholders, including consumers, providers, employers, insurance issuers, and state regulators.

D. Increase the transparency of the compliance process and the support, resources, and tools available to ensure that coverage is in compliance with parity, and concurrently improve the monitoring and enforcement process.

Report Overview

5. Parity laws guarantee coverage and access, and a substantial impact is made by making coverage comparable for behavioral health and physical health care.

A. True

B. False

6. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 generally prohibits employment-based group health plans and health insurance issuers that provide group health coverage for mental health and substance use disorders from imposing less favorable benefit limitations on those benefits than on medical / surgical benefits.

A. True

B. False

7. The 2008 parity law and its implementing regulations does all of the following, except:

A. Require a plan to cover mental health and substance use disorder services and all diagnoses.

B. Require that the financial requirements and quantitative treatment limitations applied to mental health and substance use disorder benefits can generally be no more restrictive than the predominant requirements or limitations applied to substantially all medical / surgical benefits within a specific classification.

C. Require parity in the application of non-quantitative treatment limitations.

D. Expand to substance use disorder benefits the parity requirements of the Mental Health Parity Act of 1996, which precluded plans and issuers from imposing a lifetime or annual dollar limit on mental health benefits that is lower than the lifetime or annual dollar limit imposed on medical / surgical benefits.

8. The Mental Health Parity and Addiction Equity Act does not require plans and issuers to disclose the criteria for medical necessity determinations or the reason for any denial with respect to mental health and substance use disorder benefits.

A. True

B. False

9. One of the main findings from the Oregon Health Insurance Experiment, a randomized controlled study designed to evaluate the impact of Medicaid in the United States, is that the prevalence of _____ was lower among the individuals who received Medicaid coverage.

A. Bipolar disorder

B. Substance use disorder

C. Depression

D. Mania

10. Although parity protections have been found to decrease out of pocket costs for mental health and substance use disorder services, this decrease in out of pocket consumer spending is associated with an increase in health plan spending on behavioral health treatments.

A. True

B. False

Ensuring Compliance with Parity: Enforcing the Law

11. With respect to health insurance issuers selling products in the individual and fully insured group markets, HHS has primary enforcement authority with respect to the Mental Health Parity and Addiction Equity Act only when a state elects not to enforce or fails to substantially enforce MHPAEA.

A. True

B. False

Parity Perspectives: Hearing from Stakeholders

12. The issue of awareness of parity requirements was raised most often in reference to:

A. QTLs and NQTLs

B. The appeals process for claims denials

C. Disclosure requirements for plans and insurers

D. All of the above

13. There is a general lack of awareness of the need for mental health and substance use disorder services, and in particular the need for services related to all of the following conditions, except for:

A. Eating disorders

B. Depressive disorder

C. Autism spectrum disorder

D. Substance use disorder

14. The two main stakeholder groups that discussed QTLs the most were:

A. Patients and families

B. Consumer advocates and health care providers

C. Insurance issuers and states

D. Patients and health care providers

15. Why can parity in NQTLs be difficult to assess?

A. NQTLs are often not listed in plan documents.

B. Comparisons of coverage restrictions and care management strategies between mental health / substance use disorder and medical / surgical benefits are complex.

C. Both (A) and (B).

D. None of the above.

16. Which of the following applies when there are several alternative services or medications to treat a given condition?

A. “Fail first” or step therapy

B. Prior authorization

C. Provider reimbursement rates

D. Utilization review

Actions & Recommendations

17. Despite significant national efforts to combat the prescription opioid and heroin epidemic, commenters note that health plans may not be consistently applying parity to coverage of the treatment of opioid use disorders, including coverage of FDA-approved medications to treat these disorders.

A. True

B. False

18. Recent reviews of Medicare Advantage plan benefits have shown that cost sharing for mental health services is not on par with cost sharing for other health services.

A. True

B. False

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