This October marks the tenth anniversary of the Mental Health Parity and Addiction Equity Act (MHPAEA), one of the signal achievements in the effort to expand access to mental health treatment. While both counselors and patients have benefitted from expanded insurance coverage, there is still work to be done to successfully implement this legislation.
MHPAEA was an attempt to change the philosophy of healthcare as much as an effort to improve insurance coverage. It tells insurers to provide the same treatment for mental health and substance use disorder (SUD) as they provide for physical health because mental health and SUD are, in fact, medical problems.
Much progress has been made in addressing and reducing some of the more obvious disparities in treatment by
- placing stricter limits on the number of inpatient and outpatient mental health visits;
- eliminating overly stringent precertification requirements; and
- separating deductibles from copays.
Nevertheless, insurers are still finding subtle ways to make mental health and SUD benefits less available, such as
- disparities in how health plans enact utilization management and how they define medical necessity;
- limited behavioral healthcare services offered within provider networks; and
- lower reimbursement for behavioral healthcare providers.
Taking an Active Role in Implementation and Enforcement
Implementing the law and enforcing it have been challenging, primarily because of the lack of consistency in the oversight of enforcement by federal and state regulators.
For example, if a patient or a counselor thinks coverage is being denied for reasons that violate the MHPAEA or state parity laws (which are, in some places, stricter), the first step should be talking to the insurer. The reason for denials of coverage must be made available by the insurer upon request. If treatment is denied and the patient disagrees, they should contact the plan's customer relations division immediately. Under most plans they can file a written formal appeal.
Patients and counselors can also contact the state insurance commission. A few states have filed enforcement actions against insurers. And, in some states, patients have filed class action suits against insurers. The Parity Implementation Coalition offers resources for patients who believe they have been discriminated against.
You can learn more about mental health parity here and about MHPAEA here.
The latest guidance from federal agencies was released on April 23, 2018, and included tools such as FAQs , Pathways to Full Parity (DoL’s 2018 report to Congress), a self-compliance tool, a disclosure template, an action plan from HHS, and a fact sheet to help enforce the regulations.