In July, the Biden Administration released a proposed rule that would strengthen the Mental Health Parity and Addiction Equity Act (MHPAEA or Parity Law). The law was enacted in 2008, with the goal of eliminating health insurance discrimination against care for mental health and substance use disorders (hereafter mental health) to help ensure a general equality, or parity, between coverage for those services and for medical and surgical services. Unfortunately, major parity problems remain in pivotal, but complex areas like network adequacy and reimbursement rates. At a time of national mental health crisis, this is an issue of access to life-saving care for children, adolescents, and adults.
APA Services submitted comments on the proposed rule, believing that the rule—with the changes urged by us and other mental health organizations—will be a bold step toward making parity a reality, and toward addressing the current mental health crisis.
APA Services’ five key points are:
- Urge the administration to eliminate the proposed exceptions that would relieve health plans and insurers of major compliance obligations if they claim to be relying on independent clinical standards or combating fraud, waste, and abuse. Those overbroad exceptions threaten to undo the benefits of the proposed rule.
- Applaud the required use of outcomes data that would require insurers to collect specific data and take reasonable action to address differences when such data shows discrepancies between access to mental health and medical and surgical care. If the data shows such differences related to network composition (also known as network adequacy), the insurer would be deemed to be noncompliant. We also urge the removal of the undefined requirement that differences must be “material” before an insurer must take action and be found noncompliant.
- Urge that insurers provide key data elements relevant to network composition, such as whether providers are available to take new patients and wait times.
- Recommend that Employee Retirement Income Security Act (ERISA) plans that use third party administrators (TPAs) include contract terms that TPAs must help the plan provide required information to patients and regulators. We also recommend that plans should have the option to make the TPAs responsible for parity compliance on matters that the TPA controls, like network composition and reimbursement.
- Urge the administration to delay any “safe harbor” proposal around network adequacy (insurers would not be subject to enforcement if they met certain network metrics) until they have fully analyzed and validated that the new data requested actually demonstrates fair access to mental health benefits.
Our comments also respond to claims by parity opponents that the proposed rule would harm employers. We explain why the proposal, with our suggested changes, would actually benefit employers and make compliance easier.
In addition to submitting our own comments, APA Services initiated a campaign to engage our advocacy network in submitting its comments on the proposed rule. Over a nearly month-long span, a strong showing of approximately 1,500 comments—out of the 9,500 total—were submitted by our psychologists. In addition, 27 state psychological associations submitted their own comments. We thank those members and associations for helping with this important campaign.
Lastly, APA Services played a critical role in developing a joint comment letter (PDF, 298KB)opens in new window on the proposed rule (signed by nearly 80 national organizations) and joint comments on the data requirements (mentioned in No. 2 above). The agencies will now review the nearly 10,000 comments they received.
For more information, contact Legal and State Advocacy, APA Practice Directorate.
