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  • Behavioral Health Services > Mental Health Parity And Addiction Equity Act Of 2008 (MHPAEA)

    On October 3, 2008 Congress enacted the Health Parity and Addiction Equity Act of 2008 (MHPAEA). The MHPAEA is a federal law that applies to large group, Medicare and Child Health Plus members whose group enrolled in a plan on or after October 3, 2009.

    Under the MHPAEA, the expanded coverage for behavioral health services enacted by the New York State legislature under Timothy's Law was further enhanced to include substance abuse treatment and non-biologically based mental health treatment.

    As a result of the MHPAEA, there is no day or visit limitation for members covered by the act who have a behavioral health benefit and meet medical necessity criteria. Prior approval requirements continue to apply to these services.

    As of November 1, 2009 there are no limits to behavioral health services for Child Health Plus members.

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    Glossary terms found on this page:

    Conditions that affect thinking and the ability to figure things out that affect perception, mood and behavior.

    Specific circumstances or services listed in the contract for which benefits will be limited.

    A nationwide insurance program for the disabled and people age 65 and over, created by the 1965 amendments to the Social Security Act and operated under the provisions of the Act. It consists of two separate but coordinated programs, Part A and Part B.

    An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.

    Conditions that affect thinking and the ability to figure things out that affect perception, mood and behavior.

    The process of obtaining advanced approval of coverage for a health care service or medication. The request for services is reviewed to assess medical necessity and appropriateness of elective hospital admissions and non-emergency outpatient services before the services are provided. Also called pre-authorization or pre-certification or pre-determination.

    The use of one or more drugs for purposes other than those for which they are prescribed or recommended.


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