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February 2017  Volume 15, Number 2        

health benefits

Government Cracks Down on Parity of Coverage Violators

Prior to leaving the White House, the Obama administration increased enforcement of laws requiring parity of coverage for mental health and substance abuse benefits.

In a White House task force report, officials said insurers need to make sure that insurance coverage for treatment for mental health and substance abuse disorders are comparable to—or at parity with—other conditions such as cancer and heart disease.

“Broadly, parity laws and regulations aim to eliminate restrictions health plans place on mental health and substance abuse coverage—like annual visit limits, higher copayments, separate deductibles for mental health and substance abuse disorders, and rules on how care is managed (such as pre-authorizations of medical necessity reviews)—if comparable restrictions are not placed on medical and surgical benefits,” the authors wrote in the report.

While federal laws and rules requiring mental health parity have been adopted over the last two decades, the task force found compliance has been lagging. The task force called for more audits of health plans and warned insurers against placing stricter requirements on mental health and substance abuse services than on other types of medical care. Over the last five years, the Labor Department has conducted more than 1,500 investigations of potential parity violations and issued 171 citations for noncompliance by employer-sponsored health plans.

Most employer-based health plans, but not all, must offer parity in their coverage of mental health and substance use services. These include private employer plans with 51 or more workers and smaller employers that started offering benefits or made major changes to their health benefits after the Affordable Care Act went into effect in 2010.

The report comes amid a continuing public health crisis of untreated mental and substance abuse disorders in the United States. In 2015, one out of every five adults in America met the criteria for a mental illness or substance use disorder and only 39 percent of them received services, according to the Substance Abuse and Mental Health Services Administration.

“Half of us will be diagnosed with a mental illness during our lifetime,” Paul Gionfriddo, president and CEO of Mental Health America, said in a statement. “Mental illnesses are as costly as cancers, and serious mental illnesses reduce life expectancy by more than twenty-five years. 57 percent of adults with mental illnesses say that they do not have access to mental health care. Mental illnesses are diseases of childhood, with half emerging by the age of fourteen. But only one child in every twenty-eight with a mental health condition receives compensatory education services to help them succeed in school despite that condition.”

The task force report preceded U.S. Senate passage of the first major mental health legislation in a decade—the 21st Century Cures Act. Former President Obama signed it into law before he left office. The bill strengthens laws mandating parity for mental and physical health care.

“The 21st Century Cures Act marks a giant step forward in fixing our broken mental health system,” U.S. Sen. Bill Cassidy, R-La., said in a statement. “It institutes comprehensive mental health care reform and makes resources available to the millions that have been previously denied treatment due to a lack of access.”

The bill requires federal agencies to report on enforcement actions related to the mental health parity law and establishes an enforcement “action plan” informed by key stakeholders. It also requires the government to audit a health plan if it is found to have violated existing mental health parity laws.

“For too long, our behavioral health policy has been mired in post-crisis, deep-end, stage four thinking,” Gionfriddo said. “We have spent far too much time and far too many resources dealing with mental illnesses in courtrooms, jails and prisons, maintaining a 21st century revolving door for routine hospitalization, frequent incarceration, and chronic homelessness. Meanwhile, we have spent far too little time investing in prevention, early identification and intervention, and integrated health and behavioral services that promote recovery and change the trajectories of lives for the better.”

For more information on parity of coverage laws, please contact us.

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In this issue:

This Just In...

Bosses’ Top Concern is the Employer Mandate

3 Tips to Expand Voluntary Benefits and Save Money

Government Cracks Down on Parity of Coverage Violators

Balances in Health Savings Accounts Grow by a Third



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