In a final report (PDF, 918KB) released Oct. 27, 2016, the White House’s Mental Health and Substance Use Disorder Parity Task Force offered several recommendations for better implementation and enforcement of the federal parity law.
In several key respects, the task force adopted suggestions or responded to concerns from the Practice Organization on how to advance enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA). The law requires insurance companies providing coverage for mental and behavioral health treatment to ensure that that coverage is comparable to coverage for physical health treatment.
However, with the election of Donald Trump to the presidency, it is difficult to say whether recommendations from the task force, which was established by President Barack Obama in March, will be implemented. In fact, if Congress repeals the Affordable Care Act (ACA), one of Trump’s priorities during his first 100 days in office, parity protections extended by the ACA may be eliminated immediately or over time.
The ACA expanded the reach of MHPAEA primarily by creating health insurance exchanges (HIXs). Plans sold through the exchanges were required to comply with the MHPAEA and provide mental health and substance abuse disorder services. The creation of the exchanges extended parity to millions of Americans who were uninsured, were under plans without mental health coverage, or were covered by small employer or individual insurance plans that were exempt from MHPAEA.
The Practice Organization’s government relations staff have received indications that Congress will vote to repeal the Affordable Care Act before Trump’s first State of the Union Address takes place. The health care exchanges would remain in place for a few years while Congress and the Trump administration develop whatever would replace the ACA.
If the ACA is repealed, the Practice Organization will urge Congress to include mental health parity provisions that cover all health insurance plans in any legislation proposed to replace the ACA, and to maintain parity in the exchange plans during the transition period. The Practice Organization will also push for implementation of the task force’s recommendations in the new administration.
Task force seeks to increase plan disclosures and audits
One of the task force’s recommendations addresses health care providers’ access to information on an insurance plan’s limits on medical and surgical benefits. Having that information available would allow practicing psychologists and their patients to assess whether the plan is applying comparable constraints to medical care. As the Practice Organization pointed out in its Aug. 31, 2016, comment letter (PDF, 433KB) to the task force, that information has been difficult to access, but is essential to determining whether there is a parity violation.
The task force has recommended that Congress clarify requirements regarding benefits disclosure for all health plans. The task force also called for the development of simpler and more standardized disclosure tools.
Responding to the Practice Organization’s longstanding concerns about enforcement and transparency of enforcement, the task force announced in the report that the Department of Labor (DOL) will release annual data on closed federal parity investigations, and recommends that DOL have the power to levy civil monetary penalties.
To bolster state enforcement, the task force announced that the Centers for Medicare and Medicaid Services (CMS) will award $9.3 million to state agencies to help insurance regulators enforce the parity law. Federal agencies should also have additional funding added to their future budgets to expand enforcement efforts at the federal level and increase the number of health plan audits that agencies can perform.
The task force’s report includes many other recommendations that expand the parity law and its principles to TRICARE, Medicare and Medicaid plans.
Additional information on the MHPAEA is available on the Practice Central webpage. If you have questions about the law and its application, or questions about the task force’s recommendations, contact the Practice Organization’s Office of Legal and Regulatory Affairs by email at or call (202) 336-5886.
Editor's note: This article was updated Dec. 1, 2016, to reflect potential effects of the 2016 presidential election.