APA Establishes Webpage Addressing State Health Exchanges

Mon August 27, 2012

(Arlington, VA) - The APA has established a webpage to guide its DBs and their members as they work with their states to develop state health exchanges, ensuring the exchanges include benchmark plans that are based on the state’s current mental health coverage and are  in compliance with the parity requirements of MHPAEA.

Under the Affordable Care Act all states are required to have established health insurance exchanges (or have them established by the Federal government if they fail to do so) by January 1, 2014. The qualified health plans (QHPs) that will be offered by the exchanges are required to cover essential health benefits (EHBs) in ten categories, one of which is mental health (including substance abuse disorders).

Because of the requirement that all plans offer a mental health benefit, the plans will have to comply with the terms of the 2008 mental health parity law (MHPAEA). States have been assigned the task of designing the EHBs that will be offered by the plans in their exchanges, with the stipulation that these benefits may not fall below those provided by a benchmark plan offered in the state.  HHS has said the EHB benchmark plan a state may use must be either:

  • the largest plan by enrollment in any of the three largest small group insurance plans in the state’s small group market;
  • any of the largest three state employee health benefit plans by enrollment;
  • any of the largest three Federal Employee Health Plan options by enrollment; or
  • the largest insured commercial non-Medicaid HMO operating in the state.  

To contact the Division of Advocacy staff for assistance and to provide feedback as you work through establishing the exchanges, email us at hsf@psych.org or leave a message 866.882.6227.

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