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U.S. Departments push for mental health parity and substance-use disorder equity in health plans

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U.S. Departments advocate for mental health parity and substance-use disorder equity in health plans

In a 2022 report on the Mental Health Parity and Equity Act of 2008 issued to Congress on Tuesday, findings suggest health plans and health insurance issuers are failing to provide the proper mental health and substance-use disorder benefits to those under coverage.

The U.S. Departments of Labor, Health and Human Services, as well as Treasury, issued their 2022 Report to Congress on the Mental Health Parity and Equity Act (MHPAEA) of 2008 on Tuesday.

The report shows health plans and health insurance issuers are failing to provide the proper mental health and substance-use disorder benefits to those under their coverage.

In general, the 2008 act states that financial requirements and treatment limitations, like copayments, imposed by a health plan or issuer cannot more restrictive on mental health services or substance-use disorder benefits than the those that apply to all medical and surgical benefits. The report cites specific examples of health plans and health insurance issuers failing to ensure parity. For example, a health insurance issuer covered nutritional counseling for medical conditions like diabetes, but not for mental health conditions such as anorexia nervosa, bulimia nervosa and binge-eating disorder.

“It’s much easier to get help from a physical illness like the flu than it is going through a mental health emergency. I don’t know if anyone’s experienced it, but it’s really difficult.” Secretary of Labor, Marty Walsh, said.

In a teleconference Tuesday morning, Walsh added this is an issue he takes personally.

“As someone in active recovery, protecting access to mental health and substance use disorder treatment, it’s important to me personally and as Secretary of Labor,” he said.

The Department of Labor’s Employee Benefits Security Administration (EBSA) said it's taking unprecedented steps to enforce the law and to ensure that the agency is using its full authority to facilitate access to mental health and substance-use disorder treatment. Similarly, HHS through its Centers for Medicare & Medicaid Services (CMS) has increased its MHPAEA enforcement activities in the individual and fully insured group markets in states where CMS has enforcement authority and over non-Federal governmental plans in all states.

“Access to mental and behavioral health support is critical as the COVID-19 pandemic continues to impact so many lives across the country,” said U.S. Secretary of Health and Human Services Xavier Becerra. “Unfortunately, as today’s report shows, health plans and insurance companies are falling short of providing access to the treatment many working families need. We are committed to working with our federal partners to change this and hold health plans and insurance companies accountable for delivering more comprehensive care.”

The report outlines the departments’ efforts to interpret, implement and enforce the amendments to MHPAEA made by the Consolidated Appropriations Act 2021. The act provided the departments with an important new MHPAEA enforcement tool and additional funding to implement it. The law also requires the departments to report findings under this new provision annually. Tuesday's issuance is the first report under this requirement.

“In the past year, the Employee Benefits Security Administration has placed great emphasis on ensuring parity for mental health and substance use disorder benefits,” said Acting Assistant Secretary for Employee Benefits Security Ali Khawar. “As we continue to strengthen and build on these efforts through regulation, enforcement and compliance assistance, EBSA is determined to deliver on the law’s promise.”

A fiscal year 2021 MHPAEA enforcement fact sheet is being issued with the 2022 MHPAEA Report to Congress. This fact sheet highlights EBSA’s landmark settlement against United Behavioral Health, as well as other enforcement data and significant results from MHPAEA investigations closed by EBSA and CMS in fiscal year 2021.

EBSA has primary enforcement jurisdiction over MHPAEA for approximately two million health plans covering roughly 136 million Americans. CMS has enforcement jurisdiction over MHPAEA in the individual and fully insured group markets in states where it has enforcement authority and over non-federal governmental group health plans, such as plans sponsored by state and local governments for their employees.