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Parity in Behavioral Healthcare: What Community Behavioral Health Leaders Need to Know

Oct 7, 2025 by
, , , , BH Organizations

parity in behavioral healthcare

Even with the 2024 rule on hold (see the APA stance below), CBHC leaders have powerful tools to press payers, strengthen contracts, and protect access.  

Prefer to watch this short video instead of reading?  Go to the 6 minutes video version!

Parity in Behavioral Healthcare – Overview

Parity in behavioral healthcare means that insurance plans must treat mental health and substance use disorder (MH/SUD) services the same as medical and surgical services — with no stricter limits on coverage, costs, or access. The Mental Health Parity and Addiction Equity Act (MHPAEA), passed in 2008, is a permanent, binding law.  

What Changed and What Didn’t in 2024 – 2025

In September 2024, federal agencies finalized a new parity rule that would have significantly strengthened enforcement. It required health plans to provide meaningful benefits for all covered conditions, expand network adequacy, and ensure outcomes for MH/SUD patients matched those for medical/surgical patients.

But by May 2025, enforcement was paused following litigation by large employer groups that self-fund their health plans. Regulators announced they would not enforce the new provisions until the case is resolved, though MHPAEA itself and the 2021 CAA requirements remain in force. Explore the APA stance on this  “pause.”

Despite the 2025 pause, the 2008 Parity laws remain in effect. Regulators continue to uncover compliance gaps in Medicaid and commercial markets, while accrediting bodies such as TJC, CARF, and COA are embedding parity into standards. New transparency tools like the Mental Health Parity Index are exposing payer performance.

For providers, the takeaway is clear: parity is still the law. Health plans must continue to show that their utilization management, reimbursement, and network rules are no more restrictive for MH/SUD care than for medical care. Only the 2024 enhancements are on hold for reassessment.

Why This Matters

For CBH leaders, parity is not just about accreditation compliance—it is leverage.  Knowing how to identify and use parity obligations in payer negotiations can directly improve access and sustainability for your programs. Download the Step-by-Step Guide to Parity Compliance.

Medicaid Parity Oversight: A Wake-Up Call

Parity isn’t just a commercial insurance issue. Medicaid and CHIP are also required to comply. An HHS Office of Inspector General (OIG) audit in 2024 found that all eight states reviewed failed to meet parity compliance deadlines. Missing contract provisions, incomplete analyses, and non-public reporting were common. Worse, OIG found evidence of outright violations, such as higher copays or stricter limits for behavioral health care (HHS OIG, 2024). CMS agreed with these findings and committed to stronger oversight, including verifying states’ parity analyses, requiring parity provisions in all contracts, and continuous monitoring (CMS, 2024).
For CBH leaders, this means more leverage with Medicaid managed care organizations: if you see inappropriate prior authorization or underpayment, you have federal backing to push back (Georgetown CCF, 2024).

Final Thought for CBH Leaders

This moment is both a risk and an opportunity: use parity requirements now as leverage to secure fairer access, reimbursement, and sustainability. 

Parity is not a distant aspiration—it is enforceable today. Even as Washington revisits the 2024 rule, MHPAEA and the CAA 2021 provide real leverage to challenge barriers, negotiate fair contracts, and protect access for clients. Accreditation bodies and public tools are adding momentum, making it harder for plans to ignore parity obligations.

Barrins & Associates

The Barrins & Associates team of accreditation and regulatory experts stands ready to help your organization prepare, respond, and excel. Through expert-led mock surveys, policy reviews, and targeted education, our consultants specialize in behavioral health and deliver tailored solutions that align with accreditation standards, regulatory requirements, and leading practices. Contact us today to strengthen your compliance strategy and survey readiness.

Barrins & Associates: Navigating accreditation, advancing compliance, and protecting access—so you can focus on delivering exceptional behavioral health care.

Additional References

  • APA Services. (2025). Federal agencies announce non-enforcement of 2024 MHPAEA final rule. Explains why enforcement of the 2024 parity rule was paused due to litigation, while confirming that core parity protections remain in effect.
  • American Hospital Association. (2024). Agencies finalize 2024 Mental Health Parity and Addiction Equity Act rule.  Overview of the Sept. 9, 2024 final MHPAEA rule: network composition standards, guardrails on NQTLs, and limits on biased data sources.
  • U.S. Department of Health and Human Services, Office of Inspector General. (2024). Most state Medicaid managed care organizations did not comply with mental health and substance use disorder parity requirements.
  • American Medical Association & The Kennedy Forum. (2025). Mental Health Parity Index. Landing page for the Mental Health Parity Index—an interactive tool (pilot in Illinois) built with AMA and Third Horizon
  • HHS Office of Inspector General. (2024). CMS did not ensure that selected States complied with Medicaid managed care mental health and substance use disorder parity requirements. (OIG)
  • CMS. (2024). State oversight of Medicaid managed care and CHIP programs: Mental health parity and prior authorization. CMS Bulletin
  • Georgetown Center for Children and Families. (2024). Federal Inspector General highlights Medicaid managed care mental health parity failings. Policy Blog