Basic Equity in Mental Health Coverage Could Be at Risk Without Federal Rule: Ali Khawar

Ali Khawar, former principal deputy assistant secretary with the Employee Benefits Security Administration, US Department of Labor, spoke about the effects of repealing the federal rule clarifying the Mental Health Parity and Addiction Equity Act.

This transcript has been lightly edited for clarity; captions are auto-generated.

Transcript

What will happen if this federal rule is repealed?

Let me give you some anecdotes of what we were seeing and what was motivational for us when we were working on this rule in the first place. We saw, and it was unfortunately relatively widespread practice, that if you had diabetes, you wouldn't really have a problem getting access to nutritional counseling. Unfortunately, if you were a teenager with an eating disorder, there would be an explicit carve-out for nutritional counseling in that insurance coverage. Now, that's not to say that if you have an eating disorder, all you need is nutritional counseling, but it's hard to argue that that's not part of a well-rounded regimen of treatment. But it just wouldn't be allowed.

Parents who had children with autism that needed access to applied behavioral analysis therapy wouldn't be able to access it because it would be excluded. And similar treatment on the medical-surgical side was not carved out. Drug testing, so urinalysis for individuals that had opioid addiction that were in treatment programs, wouldn't be covered, but urinalysis for any number of medical conditions would be covered without question. Those are the kinds of low-hanging fruit that we saw that was very troubling, because what it meant is that if you're not getting these very basic things right, what does that mean when we're talking about much, much more complicated issues like how adequate is your provider network when we're looking at the Mental Health Network vs the other health network. How difficult are you making it for providers to enter? How are your reimbursement rates? How are your post utilization review rates. All of those kinds of things are much, much harder to figure out what's actually going on. But when you see that the basics aren't being done right, from a compliance standpoint, it's very worrying about whether the hard stuff is right.