A federal report released Tuesday found insurers and health plans are failing to provide mental health and substance use treatment coverage at the same level as medical and surgery benefits. And it’s a major barrier to care, especially for those already struggling to get help. That was the message from the Departments of Labor, Health and Human Services and the Treasury in their 2022 Report to Congress on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
“As someone in recovery, protecting access to mental health and substance use disorder treatment is important to me personally and as Secretary of Labor,” said Marty Walsh on a conference call with reporters Tuesday. “It’s much easier to get help for a physical illness like the flu than it is going through a mental health emergency.”
In discussing the report, Walsh, who has been open about his experience as a recovering alcoholic, and other officials stressed that an increasing number of people have suffered behavioral health and addiction issues during the pandemic.
Walsh said that often people feel apprehensive about seeking treatment in the first place, and that many find accessing care can be an even bigger obstacle and challenge.
“You have to find your providers who take the insurance you have,” he said. “You have to figure out what requirements you need to meet for treatment to be covered by your plan.”
But implementing the parity laws on the books has been a work in progress, Walsh said. These laws require equivalent coverage: so no more limitations on mental health benefits than physical benefits for a given plan. For example, if an insurer covers all doctor visits for a physical condition like arthritis on a plan, the same plan should cover all visits for treatment of a mental health diagnosis, like generalized anxiety. Amendments made to the 2008 law in the Consolidated Appropriations Act 2021 require departments to report on how they’re interpreting, implementing and enforcing the act. Accordingly, Tuesday’s report highlights examples of actions taken to protect mental health and substance use benefits.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
A particularly prominent example involved a multimillion dollar settlement in August. The Employee Benefits Security Administration and the New York Attorney General’s Office entered into a settlement agreement with United Behavioral Health and United Healthcare Insurance and Oxford Health Insurance Inc. Among other things, the settlement resulted from practices that led to significantly lower mental health benefits and increased denials of coverage. United paid $13.6 million in restitution to participants and beneficiaries, $2.08 million in penalties, $3.35 million in attorneys’ fees and $750,000 (already paid before the settlement) to affected participants and beneficiaries. It also agreed to to change practices and committed to future compliance.
United did not respond to a request for comment before this story was published.
“Health insurance providers are wholly supportive of parity between physical and mental health and are working diligently to achieve the goals of the Mental Health Parity and Addiction Equity Act (MHPAEA),” wrote Kristine Grow with AHIP (America’s Health Insurance Plans) in an email. “Since the passage of MHPAEA, health insurance providers have introduced many innovations and improvements to expand access to mental health services.” During the pandemic, that’s included offering access to additional mental health care services and expanding mental health care via telehealth.
Grow said the process of insurance providers working with the three federal departments involved in the report demonstrated the need for compliance assistance to achieve shared mental health parity goals.
“This first experience provided valuable clarification in expectations for documentation and certification, and we look forward to continuing to work with the (three departments) to improve processes to demonstrate compliance with MHPAEA,” she said.
Federal officials say parity in mental health coverage can be difficult to enforce and suggested the law needs more teeth given the continued lag in mental health coverage. The Employee Benefits Security Administration is recommending that the Department of Labor be given authority to assess fines for parity violations.
“There are not really civil monetary penalties associated with a failure to comply with Mental Health Parity and Addiction Equity Act, and we think that’s an additional enforcement tool that would be quite helpful,” said Acting Assistant Secretary for Employee Benefits Security Ali Khawar during the conference call.
While enforcement is one element of a broader strategy to ensure parity, Khawar said it nonetheless is an important tool.
“You can be sure that the Department of Labor – and I think I can speak for our federal partners on this – we’re not going away. This is not going to cease being an important issue,” Khawar said. “We intend to ensure that we’re doing everything we can to really get to a place where compliance is the norm. And unfortunately one of the takeaways from this report is that’s not the state that we’re in right now.”
Photo: SIphotography, Getty Images
