Our Report to the President on Mental Health and Substance Use Disorder Parity

From the national opioid epidemic to disturbing rates of suicide, we see the consequences every day of untreated mental health and substance use disorders.  Access to effective mental health and substance use disorder services can mean the difference between graduating from school and falling behind; between keeping a good job and becoming involved with the criminal justice system; between living a full life in recovery and dying by overdose or suicide. But if those services are needed, will your health insurance cover them in the same way it covers other medical treatment?

Six months ago, President Obama established a Federal Task Force to help make sure the answer is yes.  

The Mental Health and Substance Use Disorder Parity Task Force was led by the Domestic Policy Council and consisted of the Departments of Labor, the Treasury, Defense, Justice, Health and Human Services, and Veterans Affairs, as well as the Office of Personnel Management and the Office of National Drug Control Policy. Our Task Force met with consumers, providers, employers, health plans, and State regulators, and read more than 1,100 public comments.

Today, we are presenting the President our final report, which includes a series of new actions and recommendations to ensure that insurance coverage for mental health and substance use disorder services is comparable to—or at parity with—general medical care.

Parity laws and regulations aim to eliminate restrictions on mental health and substance use disorder coverage – like annual visit limits, higher copayments, separate deductibles for mental health and substance use disorder services, and rules on how care is managed (such as pre-authorizations or medical necessity reviews) – if comparable restrictions are not placed on medical and surgical benefits.  Comprehensive insurance coverage that meets parity requirements can provide access to treatment and services, which in turn can reduce the difficulties faced by people with mental health and substance use disorders, help their loved ones, and increase their independence.

However, parity is only meaningful if health plans are implementing it well, consumers and providers understand how it works, and the government provides clear guidance and appropriate oversight. 

During its tenure, Task Force agencies produced a user-friendly “Know Your Rights” brochure to increase knowledge about parity; released guidance outlining plans’ obligations for disclosing information to assess their compliance with parity; and issued a best practices report based on a series of interviews with State regulators on parity implementation and enforcement.

In conjunction with the final report, the Task Force announced an additional series of immediate action steps to advance parity.  Examples of these steps include:

• $9.3 million to States to help implement parity protections.  Stakeholders told the Task Force that States need support and resources to ensure issuer compliance with parity.
• A beta version of a new parity Web site to help consumers find the appropriate Federal or State agency to assist with their parity complaints, appeals, and other actions. The Task Force received many comments about the challenges consumers face in identifying the appropriate agency that regulates their insurance coverage. 
• A Consumer Guide to Disclosure Rights to help consumers and providers understand what type of information to ask for when inquiring about a plan's compliance with parity. The Guide includes 11 scenarios, each with specific suggestions for information consumers have a right to that can help, as well as timing requirements for plans and issuers providing these documents.
• Guidance on the application of parity to opioid use disorder treatment that responds to concerns raised by consumers about insurance barriers to timely treatment.

Examples of the longer-term recommendations included in the Task Force final report include:

• Increase Federal agencies’ capacity to audit health plans for parity compliance.  Stakeholders have consistently called for enhancing audit capacity to improve oversight and enforcement of parity protections.  The Task Force concurred with this view and recommends increasing resources for this purpose.
• Allow the Department of Labor to assess civil monetary penalties for parity violations.  Commenters called for stronger enforcement tools and the Task Force recommends providing the Department of Labor with this increased authority.
• Work with the National Association of Insurance Commissioners and States to develop a standardized template that States could use to help assess parity compliance.  Commenters noted the challenge of State variation in approaches to parity oversight.
• Ensure timely implementation of new Medicaid and TRICARE parity rules.

These and the other actions and recommendations in the Task Force report build on the ongoing work of the Administration to ensure that people with mental health and substance use disorders receive the care they need. 

For example, the Affordable Care Act ended insurance company discrimination based on pre-existing conditions, including mental health and substance use disorders; required coverage of mental health and substance use disorder services in the individual and small group insurance markets; ensured that recommended preventive screenings, including for depression and alcohol misuse, are available with no co-pays; and, expanded Medicaid to millions of additional Americans, significantly improving coverage for mental health care and substance use disorder treatment.

The work of the Task Force provides a road map for moving forward so that our country will continue to make significant progress in expanding mental health and substance use disorder coverage for millions of Americans.

The final report is available here: http://www.hhs.gov/parity