For Parity, Are States in The Driver’s Seat?

In response to last week’s article “Parity Redux”—on the recent appellate court decision to overturn what was considered a landmark ruling for mental health parity— we received many comments and questions about the case’s broader impact. One concern—how will enforcement of the federal Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 happen.

Enforcement of MHPAEA rests on both the federal government and state governments. The enforcement standard is similar. Both require health plans to demonstrate parity compliance through comparative analyses of non-quantitative treatment limitations (NQTLs)—non-numerical limits such as preauthorization requirements, medical . . .