Despite the passing of the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008, clinicians in the field of mental health continue to struggle with less favorable benefits, higher co-pays and challenging pre-authorizations required to treat their patients. Although the MHPAEA was meant to reduce the burden for patients to receive appropriate mental health treatment, healthcare plans continue to violate the law and lengthy, expensive investigations aren’t sufficient enough to turn the tide.
Some of the most common violations include inadequate benefits, higher co-pays than for medical/surgical providers, limitations on the number of visits allowed and much broader pre-authorization requirements. Additionally, many plans offer lower annual dollar limits for some mental health disorders and they fail to properly disclose the benchmarks used for determining the necessity and/or their reason for denying treatment. In all of these instances, payers are in direct violation of the MHPAEA.
A study done in 2014 by the Department of Labor (DOL) estimated 9.8 million adults (age 18+) in the United States had a serious mental illness. Additionally, 15.7 million adults and 2.8 million youth (age 12-17) had a major depressive episode during the previous year. Because of these statistics and more, the Department of Labor has committed to enforcing the MHPAEA, but there is still an enormous amount of work to be done.
The U.S. Department of Health and Human Services (HHS) has now put together a Mental Health and Substance Use Disorder Parity Task Force to specifically support consumers, improve parity implementation and enhance parity compliance and enforcement. Recently, the task force released a new consumer portal designed to help patients overcome obstacles related to insurance coverage for mental health and addiction treatment. Mental Health providers can guide their patients to this portal for assistance: https://www.hhs.gov/mental-health-and-addiction-insurance-help
Additionally, the Centers for Medicare and Medicaid Services (CMS) awarded $9.3 million to states to provide help with insurance regulators that will monitor parity compliance. Also, the DOL and HHS jointly published a paper highlighting the warning signs along with many other resources that explain parity and consumer rights in a friendlier language. You can find these patient resources here: https://www.hhs.gov/about/agencies/advisory-committees/parity/index.html
While the United States has most definitely made great strides when it comes to providing care for patients with mental health disorders or suffering from addiction, there is still quite a journey ahead. As of 2016, research showed one in five American adults will suffer from some form of mental illness in the prior year. Furthermore, 20.2 million Americans will have a substance-abuse disorder. These statistics alone make mental health parity an important regulatory issue facing the healthcare industry as a whole. Take into consideration that additional research shows 50% of Americans will require mental health treatment at some point in their life and the need for complete mental health parity becomes quite urgent. Access to appropriate care is no longer an option, but an absolute necessity.