Making Mental Health and Substance Use Disorder Parity Work

One of the many important promises of both the Affordable Care Act and the Mental Health Parity and Addiction Equity Acts is to ensure that health plans treat mental health and substance use disorders the same way that they treat other health issues.  For too long Americans have paid for coverage that does not recognize that mental health and substance use disorders are every bit as important as physical health, and that going without adequate treatment can be debilitating and even life threatening.  This is especially important in light of the prescription drug abuse and heroin epidemic as well as troubling rates of suicide and severe mental illness. The President has made behavioral health a priority by focusing on the prevention, early intervention, and treatment of mental health and substance use disorders, and by signing a Presidential Memorandum creating Mental Health and Substance Use Disorder Parity Task Force, which will focus key Federal agencies on the work of ensuring that Americans receive the coverage and treatment that they deserve.   I have the privilege of chairing this Task Force, and its work is well underway.

Thanks to the Affordable Care Act, the Administration has taken action to expand access to mental health and substance use disorder benefits and coverage. 

To promote equity in the treatment of these conditions, we also have taken numerous steps to ensure that mental health and substance use disorder benefits are offer at parity with, meaning they are comparable to, medical and surgical benefits.   To help consumers realize the promise of coverage expansion and parity protections, the President directed Federal Departments and Agencies to work together to ensure that Americans are benefiting from the Federal parity protections the law promises.

The Mental Health Parity and Addiction Equity Act requires group health plans and insurers that offer mental health and substance use disorder benefits to provide coverage that is comparable to their coverage for general medical and surgical care.  In November 2013, the Departments of Health and Human Services (HHS), Labor and Treasury issued the final rule to implement parity, meaning ensuring that health plans’ features like co-pays, deductibles and visit limits are generally not more restrictive for mental health and substance abuse disorder benefits than they are for medical and surgical benefits.

Building on this framework, the Affordable Care Act requires all new small group and individual market plans to cover ten essential health benefit categories, including mental health and substance use disorder services, and to cover them at parity with medical and surgical benefits.  In February of this year, the Department of Defense issued a proposed rule to modernize the mental health and substance use disorder benefits and provide parity under their benefit plan, TRICARE.  And, on March 29 of this year, HHS finalized a rule applying parity to coverage for those enrolled in Medicaid and Children’s Health Insurance Program (CHIP) plans. 

However, we know that parity is only meaningful if health plans are implementing it well, consumers and providers understand how it works, and there is appropriate oversight.  The goals of the Task Force are to promote compliance with parity best practices; support the development of tools and resources to support parity implementation; and develop additional agency guidance as needed to facilitate the implementation of parity.  With an October 31 deadline, the Task Force will work quickly across Federal Departments and with diverse stakeholders to ensure implementation of these important parity protections.

We’ll keep you posted on our progress.