What is mental health parity, and how does CMS enforce parity?

• A. Parity means equal coverage across all services regardless of type
• B. Parity requires mental health/substance use benefit to be no more restrictive than medical/surgical benefits; CMS enforces through regulations and plan reviews
• C. Parity only applies to medication coverage
• D. Parity is optional and not enforced

Answer: (B)

Mental health parity means that coverage for mental health and substance use services in a health plan must be no more restrictive than coverage for medical and surgical services in the same plan. This isn’t about making every service identical, but about ensuring that limits on visits, treatment durations, and cost-sharing for mental health care are not more stringent than those applied to medical or surgical care. It also covers non-quantitative restrictions, such as prior authorization processes and network limitations, so they aren’t harder to access for mental health treatment. CMS enforces parity by issuing and upholding regulations and by reviewing plan designs and how plans operate during plan reviews. If a plan appears to impose greater barriers to mental health or substance use services, CMS can require changes and take corrective actions to restore parity.