Laws, Regulations, and Guidelines

Learn how specific federal laws, regulations, and guidelines pertaining to mental health and substance use impact SAMHSA and drive SAMHSA-funded activities.


A number of specific laws, regulations, and guidelines are directly relevant to SAMHSA, SAMHSA-funded activities, and to the fields of mental health and substance abuse. These cover such areas as:

  • Behavioral health services financing, access, and delivery
  • Civil rights protections
  • Medical records privacy and confidentiality
  • Substance use regulations and drug-free workplace mandates and testing

Behavioral Health Services Financing, Access, and Delivery

Many federal laws and regulations impact behavioral health services financing, access, and delivery. Several of the key laws and regulations fall into the following five areas:

  • Patient Protection and Affordable Care Act
  • Mental Health Parity and Addiction Equity Act (MHPAEA)
  • SAMHSA Laws and Regulations
  • Emergency Response
  • Charitable Choice

Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act (PL 111-148) is one law that brought significant reform to the health care system. The Affordable Care Act makes health insurance more affordable for individuals, families, and small business owners. People living with mental or substance use disorders often have problems getting private health insurance. Now there are special insurance protections to help.

Under the Affordable Care Act, mental health and substance use disorder services are among the 10 essential health benefits that most health insurance plans must cover. This includes behavioral health treatment, counseling, and psychotherapy. For providers, the Affordable Care Act means a shift to new models of integrated care, such as health homes that coordinate care for people with chronic conditions, and value-based payment initiatives such as accountable care organizations (ACOs) that tie reimbursement to health outcomes.

To understand how the health care law significantly improves insurance coverage for people with mental and substance use disorders, go to the Health Financing topic. Also, learn about key regulations to implement the Affordable Care Act.

Mental Health Parity and Addiction Equity Act (MHPAEA)

The Departments of Health and Human Services (HHS), Labor, and Treasury issued the final rules in November 2013 to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) (PDF | 55 KB). Review the final rule in the Federal Register – 2013 and the Final Parity Rule Fact Sheet. For more information, go to SAMHSA’s webpage on parity.

The Act requires insurance plans offering coverage for mental or substance use disorders to make these benefits comparable to medical and surgical coverage. Deductibles, copays, out-of-pocket maximums, and treatment limitations for mental health or substance use disorders must be no more restrictive than the same requirements or benefits offered for other medical care.

Laws and Regulations Affecting SAMHSA’s Authority

The Children’s Health Act of 2000 (PDF | 531 KB) reauthorizes SAMHSA programs that work to improve mental health and substance abuse services for children and adolescents. It also provides SAMHSA the authority to implement proposals that give U.S. states more flexibility in how they use block grant funds, with accountability based on performance. The Act also allows SAMHSA to consolidate discretionary grant authorities, which provides the Secretary of HHS with more flexibility to respond to individuals and communities in need of mental health and substance abuse services. It also provides a waiver from the requirements of the Narcotic Addict Treatment Act, allowing qualified physicians to dispense (and prescribe) Schedule III, IV, or V narcotic drugs, or combinations of such drugs, approved by the Federal Drug Administration to treat heroin addiction. Additionally, the Act provides a comprehensive strategy to combat methamphetamine use.

SAMHSA’s other programs and components have been authorized by several laws including:

Emergency Response

The Mental Health and Substance Abuse Emergency Response Procedures (CFR Title 42: Part 51d) details grant application requirements for states and Indian tribes to support local community emergency responses related to substance use and mental illness. The regulation governs SAMHSA’s role in responding to behavioral health needs that arise following natural or human-caused emergencies.

Charitable Choice

Provisions of the SAMHSA Charitable Choice regulations are designed to strengthen the capacity of faith-based and other neighborhood organizations to deliver services effectively to those in need and provide people with a choice of SAMHSA-supported substance use prevention and treatment programs. Provisions also ensure that funding administered by SAMHSA is accomplished without impairing the religious character of such organizations and without diminishing the religious freedom of SAMHSA beneficiaries.

The Charitable Choice regulations are applicable to:

Grant program applicants are required to certify that they will comply with all SAMHSA Charitable Choice provisions and implementation regulations as part of their application for funding. SAMHSA’s Fact Sheet on Charitable Choice Regulations – 2004 (PDF | 134 KB) provides a quick summary of the regulations.

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Last Updated: 09/15/2017