Required SUD Treatment Coverage
- SUD screening and brief intervention: ACA requires $0 cost-sharing
- Medication-assisted treatment (MAT): Buprenorphine, naltrexone, methadone — must be covered with parity
- Outpatient treatment: Individual and group counseling — must be covered with parity
- Intensive outpatient programs (IOP): Structured outpatient treatment — must be covered with parity
- Residential treatment: Inpatient SUD treatment — must be covered with parity
- Detoxification: Medical management of withdrawal — must be covered with parity
MAT: The Gold Standard
Medication-assisted treatment (MAT) is the gold standard for opioid use disorder. MAT combines FDA-approved medications (buprenorphine, naltrexone, methadone) with counseling and behavioral therapies. MAT reduces opioid use by 50–70%, reduces overdose deaths by 50%, and reduces criminal activity by 60%. Plans that impose prior authorization barriers to MAT are likely violating MHPAEA.
MHPAEA and SUD
Compliance Note
SUD treatment benefits are among the most actively enforced areas of MHPAEA compliance. Plans that impose prior authorization requirements for SUD treatment that are more stringent than for comparable medical/surgical treatment are violating MHPAEA. Plans that limit residential SUD treatment to fewer days than comparable medical/surgical inpatient treatment are violating MHPAEA. Review your SUD treatment benefits for parity compliance.