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Have you ever wondered, “why is getting affordable therapy so difficult?” After all, don’t we have mental health parity protections in the US?
This problem is what the Biden-Harris administration is now focusing on. With new efforts to enforce mental health parity laws, mental health access is on the path to affordability for more Americans.
So, what can consumers and mental health providers expect with these new efforts? We asked 2 experts to make sense of the new proposed rule around mental health parity.
First off, what is mental health parity?
As described by the National Alliance on Mental Illness (NAMI), “mental health parity describes the equal treatment of mental health conditions and substance use disorders in insurance plans.”
To provide one example, this could mean that if you get unlimited doctor visits for a physical condition like diabetes, you should also get unlimited visits for a condition such as anxiety.
Mental health parity means that mental health services are covered at the same rate as physical health services. This is in reference to copays, deductibles, number of visits, and more.
This is important because, as the Department of Labor (DOL) put it in a report to Congress: “Mental health is crucial to the overall health and well-being of every person, and access to quality [Mental Health/ Substance Use Disorder] care is as essential for health as access to quality medical/surgical care.”
In other words, we need to recognize that mental health is as important as physical health.
So, why is the Biden-Harris Administration focusing on mental health parity now? And why is it important?
To quote from the same DOL report, “the United States is experiencing a mental health and substance use disorder crisis, exacerbated by the COVID-19 pandemic. The crisis is impacting children and adults nationwide and across demographics, with marginalized and underserved communities affected disproportionately.“
Mental health parity helps people in these ways:
As Brittainy Lindsey, business consultant and former therapist, puts it:
“This legislation should specifically matter to individuals who've been denied coverage or payment for mental health services by their insurance carrier, or those who have not been adequately supported by their health plans to locate timely, accessible and affordable mental health services, including addictions treatment.”.
To fully understand the new rules, let’s take a short tour through the history of mental health parity laws. We’ll end with covering challenges that we’re currently facing.
There are 3 laws that affect mental health parity in the US. Let’s cover them briefly here.
According to the Centers for Medicare and Medicaid Services (CMS), “the Mental Health Parity Act of 1996 (MHPA) provided that large group health plans cannot impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical/surgical benefits.”
In plain English, large group health plans must ensure parity between medical/surgical benefits and mental health benefits.
Next, there were some key changes made to the MHPA with the Mental Health Parity and Addiction Equity Act in 2008.
Here’s a short list of key changes:
These were all welcome improvements as far as the mental health community was concerned. Yet, it turns out there were many loopholes that insurance companies could exploit to avoid paying. This leads us to the Consolidated Appropriations Act of 2021.
This act required health insurance plans to perform and document comparative analyses of their service offerings. Their medical/surgical benefits must be similar to their MH/SUD benefits, and these analyses must be provided to relevant departments upon request.
Using these analyses, our government can provide stronger enforcement of rules. These analyses show where insurance plans are failing their plan holders.
As Brittainy Lindsey put it: “According to the 2022 Report to Congress last year, federal regulators noted that none of the comparative analyses reviewed on audit were sufficient. That means, widely and systemically, health insurers aren't following MHPAEA law.
“The hope is that cracking down on auditing and compliance efforts will hold health plans more accountable to fair, transparent and equitable access to mental health treatments for individuals seeking therapeutic services payable through their insurance benefits.”
At the end of this article, we’ll provide a link you can use to make your voice heard.
Moving along, have there been any challenges in enforcing mental health parity laws?
To understand the problems with mental health parity, I turned to Sarah Verducci, a licensed therapist and product manager for mental health tech companies:
“Mental health parity still needs a lot of work. Across the board, it's a known fact that insurance companies often fail to adequately reimburse mental health services in comparison to other healthcare services of comparable training requirements. Consequently, a large percentage of therapists are compelled to operate independently, outside of the medical system.”
Due to lack of enforcement, some therapists may be discouraged or leave the profession altogether. Others may strike out on their own and try practicing without accepting insurance.
“However,” continues Sarah, “the ramifications of mental health parity extend far beyond therapists and those seeking therapy. The heart of the matter lies in creating an inclusive system wherein accessible care is available to all, precisely when they require it. This is about nurturing the overall well-being of our society.”
Luckily, the Biden-Harris administration is making efforts to improve this.
“According to the 2022 Report to Congress last year, federal regulators noted that none of the comparative analyses reviewed on audit were sufficient. That means, widely and systemically, health insurers aren't following MHPAEA law” says Brittainy Lindsey.
“The hope is that cracking down on auditing and compliance efforts will hold health plans more accountable to fair, transparent and equitable access to mental health treatments for individuals seeking therapeutic services payable through their insurance benefits.”
To all the people who want to use their insurance benefits for therapy, take heart knowing that people in the government are fighting for you.
Continues Lindsay:
“This legislation should specifically matter to individuals who've been denied coverage or payment for mental health services by their insurance carrier, or those who have not been adequately supported by their health plans to locate timely, accessible and affordable mental health services, including addictions treatment.”
Non-Quantitative Treatment Limitations (NQTLs) have also caused some concern.
NQTL is the name given to those things that insurance plans use to limit or deny treatment and which can’t be measured in numbers.
According the CMS, a few examples include:
• “standards for provider admission to participate in a network, including reimbursement rates”
• “plan methods for determining usual, customary, and reasonable charges”
• “fail-first policies or step therapy protocols”
• “exclusions based on failure to complete a course of treatment”
• “restrictions based on geographic location, facility type, provider specialty, and other criteria that limit the scope or duration of benefits for services provided under the plan or coverage.”
Under the MHPAEA, a plan’s NQTL’s cannot be more stringent for MH/SUD than for medical/surgical benefits.
In essence, the proposed rule for mental health parity attempts to ensure that Americans don’t face barriers to receiving mental health and substance use disorder treatment. Any barriers or limitations that they do face should be no more stringent than those faced when seeking similar medical/surgical care.
Here are some more considerations for the proposed role to address:
For an insurance plan to provide mental health benefits, there needs to be enough service providers in their network. There is now a rule focused on ensuring enough providers and a diversity of providers contracted with each insurance plan.
This will improve the quality and availability of services to those who use their insurance.
So, when can you expect to see progress from the White House’s efforts?
“I expect that the proposed rule could take effect as soon as January 2024 to encourage health plans [to] adopt improved compliance as quickly as possible. While I hope this proposed legislation is adopted and bolsters compliance with existing federal law for the benefit of patient-consumers, I also expect insurers to resist and argue against compliance, find new loopholes, and continue to prioritize their own profit margins by not paying for the [medically] necessary healthcare services individuals need,” Brittainy Lindsey told me.
I also followed up with Sarah Verducci on how the Biden-Harris administration’s efforts will affect therapy-seekers:
“While some progress has been made around mental health parity since efforts began in 1996, it has overall failed to assist the average person in receiving the care they need. My impressions of the Biden Administration's current efforts are that they are taking parity beyond mere philosophy and are requiring insurers to demonstrate how they have turned it into a reality. By holding insurers accountable for the outcomes of their implementation of parity, the hope is that we will witness increased access to care.”
As you can see, there’s is still a lot of work left to be done for advocates, mental health workers, and clients.
We still have a long way to go, and the proposed rule is not destined to become the law. So, let’s all do our part to ensure mental health parity for all Americans.
If you’d like to make your voice heard, take 15 seconds to send an email here: mhpaea.rfc.ebsa@dol.gov
Tell them what mental health parity means to you, your clients (if applicable), and what changes you’d like to see. Tell them what affordable mental health services could do for the people you care about.
Making your voice heard now can make mental health more affordable in the near future, so click the link now and send an email.
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This blog post is provided for informational purposes only and is not intended as legal, business, medical, or insurance advice. Laws relating to health insurance and coverage are complex, and their application can vary widely depending on individual circumstances and state laws. Similarly, decisions regarding mental health care should be made with the guidance of qualified health care providers. We strongly recommend consulting with a qualified attorney or legal advisor, insurance representative, and/or medical professional to discuss your specific situation and how the laws apply to you or your situation.
