Mental Health Task Force Seeks Tougher Enforcement of Parity Law

A White House task force report seeks stricter, more proactive enforcement of the 2008 parity law, which says health plans must provide the same benefits for mental health and substance abuse care as other medical conditions.

Along with the report, CMS is awarding $9.3 million to states to enforce parity protections, and HHS has released the beta version of a new consumer website to help patients and families find the right agency for their complaints or appeals.

“These disorders affect society in ways that go beyond the direct cost of care,” the report stated. “Without effective treatment, people with these conditions may find it difficult to find or maintain a job, may be less able to pursue education and training opportunities, may require more social support services, and are more likely to have their housing stability threatened.”

President Barack Obama launched the task force March 29, 2016, to bring domestic policy leaders together with officials from the departments of Treasury, Defense, Labor, Justice, Health and Human Services, and Veterans’ Affairs, along with the Offices of Personnel Management and National Drug Control Policy. This step, the report said, recognized that “parity is only meaningful if health plans are implementing it fully, consumers and providers understand how it works, and there is appropriate oversight and enforcement.”

The 2008 parity law, formally called The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Act, was embodied in the 2010 Affordable Care Act legislation, which the task force report said has brought mental health and substance abuse services to 15 million more people.

But complaints about gaps persist, especially with the escalation of the nation’s opioid and heroin epidemic. Parity, as the White House statement noted, “aims to eliminate restrictions on mental health and substance abuse coverage—like annual visit limits, higher copayments, or different rules on how care is managed, such as preauthorization requirements or medical necessity reviews—if comparable restrictions are not placed on medical and surgical benefits.”

Former US Representative Patrick J. Kennedy, a chief author of the 2008 parity law, said the report is “a great start,” but called on insurers to do their part. Much of the report, he said in a statement, “still places the burden of real action squarely on the shoulders of the patients living with these conditions.”

Thus, Kennedy said, patients and families must still fight the battle themselves when a parity issue arises, which is often “at the height of their crisis.”

Besides the new enforcement dollars and the new consumer portal, the task force seeks:

• Simpler disclosure tools for consumers, and called for templates to be developed with the National Association of Insurance Commissioners (NAIC).
• Better consumer education about parity protections, including a Consumer Guide to Disclosure Rights.
• An end to the opt-out provision for self-funded, non-federal government health plans. Congress would have to approve this, which would affect thousands of employees in state and local governments.
• Better reporting and fuller disclosure of federal parity investigations, and resources to conduct proactive parity audits, instead of acting after consumers complain.
• Approval from Congress for the US Department of Labor to fine health plans that don’t follow the law.
• Help from HHS’ Substance Abuse and Mental Health Services Administration (SAMHSA) to train state officials. SAMHSA will host 2 policy academies in 2017 and work with NAIC on templates to gauge compliance.
• More work to give examples of “warning signs” of non-compliance, especially for non-quantitative treatment limitations.
• Reviews of how Medicare is complying with parity. Specifically, the task force wants Congress to end the lifetime day limit in Medicare Part A in psychiatric hospitals.
• An expansion of treatment services in TRICARE, which provides benefits to the military and is governed by different statutes.
• Updates on how the parity law affects services for opioid use disorder.

America’s Health Insurance Plans (AHIP), the largest industry trade group, announced its support for the task force’s findings. In a statement, AHIP said, “Health plans are committed to parity. We will continue to work hard to implement these changes. … The report also recognizes the need for clearer, more consistent guidance on parity compliance for everyone.”

The American Psychiatric Association (APA) also endorsed the task force recommendations.

“APA welcomes this much-needed report to strengthen implementation and enforcement of existing mental health parity laws,” said APA President Maria A. Oquendo, MD, PhD, in a statement. “Full implementation and stronger enforcement will help ensure that psychiatric conditions are treated the same as other illnesses and individuals can access the treatment they need.”