Federal Agencies Submit Report to Congress on Parity
By Shalini Wickramatilake, MHS
Recently, the U.S. Departments of the Treasury, Labor (DOL), and Health and Human Services (HHS) released their 2022 Mental Health Parity and Addiction Equity Act (MHPAEA) Report to Congress.
This report indicates that health insurers are failing to deliver parity for mental health (MH) and substance use disorder (SUD) coverage for their beneficiaries.
The report also describes the federal government’s efforts to better enforce MHPAEA, and offers recommendations on how to strengthen parity implementation.
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires health insurance companies that cover both mental health/substance use disorder (MH/SUD) and medical/surgical services to cover MH/SUD services in a manner that is no less restrictive than medical/surgical services. This parity requirement applies to both quantitative (e.g. number of visits, number of days) and non-quantitative (e.g., prior authorization, proof of medical necessity) treatment limitations (NQTLs). The impetus for the passage of MHPAEA was higher out-of-pocket spending requirements and more stringent treatment limitations for MH/SUD benefits. Despite the intent of this legislation in reducing discrimination and barriers to care for individuals in need of MH/SUD care, challenges remain to full implementation of the law, and moms with mental health and substance use disorders still face barriers to coverage.
In 2020, through the Consolidated Appropriations Act, lawmakers required insurers to perform and document comparative analyses of MH/SUD vs. medical/surgical NQTLs by February 2021. As described in the new report to Congress, many insurers were not prepared to submit their comparative analyses in time for the deadline. Those who did submit comparative analyses did not offer substantive or meaningful comparisons between health coverage for MH/SUD vs. medical/surgical care. As described in the report, “None of the comparative analyses… reviewed to date contained sufficient information upon initial receipt.” DOL has issued letters to 80 health insurance plans outlining deficiencies in the comparative analyses they submitted. Additionally, DOL found that 48 NQTLs imposed on MH/SUD benefits violated parity requirements.
The findings of this report are not surprising and still very disappointing, especially given the rising rates of mental health and addiction issues during the pandemic, and the critical need to help individuals access care.
In particular, those with maternal mental health and/or substance use disorders need to have ample insurance benefits to ensure access to services during a particularly vulnerable time.
The federal government must have the authority to enforce compliance with MHPAEA, including issuance of fines to health plans for parity violations.
Related Blog Posts:
2020 Mom Announces 2022-2025 Strategic Priorities and New Board Members Priya Bathija, Rosanna Durruthy & Julie Stadlbauer
National maternal mental health advocacy non-profit announces its focus on improvements to screening and diagnosis, insurance coverage and reimbursement, and build-up of providers and treatments, as it expands its Board of Directors.
Washington, DC - January 25, 2022 - FOR IMMEDIATE RELEASE
2020 Mom today announced its 2022-2025 strategic priorities and the addition of Priya Bathija of the American Hospital Association (AHA), Rosanna Durruthy of LinkedIn, and Julie Stadlbauer of Progyny as new members of its Board of Directors.
New Model State Parity Legislation Named in Honor of Former U.S. Rep. Jim Ramstad
Tool will help policymakers increase access to mental health and addiction care amid historic rates of overdoses and suicides across the nation
Today, The Kennedy Forum released the Jim Ramstad Model State Parity Legislation, which will hold health insurers accountable for discriminating against those with mental health and substance use disorders by wrongly denying coverage of care.
Build Back Better Act: How it Supports Moms and Families
Last week, the House of Representatives passed the Build Back Better Act, a $1.75 trillion legislative package that aims to address social welfare. It will be considered by the Senate in the weeks ahead. In addition to critical maternal mental health legislation included in the package, several other provisions that impact moms are currently included in the package as well: