What’s Confusing Us About Mental Health Parity
The Mental Health Parity and Addiction Equity Act (MHPAEA) has been law since 2008. MHPAEA provided that health plans could not limit mental health or substance use disorder benefits in a way that was more restrictive than how most medical/surgical benefits were limited. This sounds simple enough, but in this year alone there has been a White House task force, voluminous Department of Labor guidance, a SAMHSA best practices manual, and an Energy & Commerce Committee hearing to find out why most people still can’t access care.
We still don’t have all the answers. The issues these efforts have uncovered are numerous: coverage criteria for medical/surgical benefits are often considered proprietary so comparison is impossible; benefit denials often do not offer enough information to allow consumers to appeal; independent reviewers sometimes have perverse incentives when looking at appeals; and the list goes on. All of these issues are exacerbated by growing pains as regulators, health plans, providers, and patients work out their rights and responsibilities under the law. In fact, a bill just passed by Congress will clarify what is even required for health plans to be compliant with parity rules.
Unless there is further guidance on this point, one thing will still confuse us — people still won’t be access a number of cost-effective and evidence-based behavioral health services, and the role of MHPAEA in addressing this issue is unclear. [...]
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addiction health care reform health law policy insurance mental health public health regulation