TCIV Spotlight: Policy, Transparency Will Drive Parity Compliance

From the Affordable Care Act and the Mental Health Parity and Addiction Equity Act to last year’s SUPPORT for Patients and Communities Act, significant legislative progress has been made over the past decade with regards to expanding access and coverage for mental health and addiction treatment, says Mark Covall, president and chief executive officer of the National Association for Behavioral Healthcare.

Still, significant work remains, particularly with regards to parity enforcement.

Covall will discuss federal policy changes that could impact treatment center operators, payers and employers at the upcoming Treatment Center Investment & Valuation Retreat. Ahead of his appearance in Scottsdale, he spoke with Behavioral Healthcare Executive about how payers could be held more accountable for parity compliance, as well as what industry executives should watch for in next year’s election.

Editor’s note: This interview has been edited for length and clarity.

The parity law was expected to have a significant impact in terms of bringing coverage of addiction treatment and behavioral healthcare in line with physical healthcare, but a study published last week shows that parity is trending in the wrong direction. Do you expect legislators to revisit these laws to see how they might be able to put more teeth into their enforcement?

I agree that the parity law has not been fulfilled, whether from intent or specific requirements that are put on health insurance plans. We are very concerned about that. I think there’s a number of avenues that are being pursued by organizations like ours and others. I would say the study you referred to is another important indicator that health plans are not following through on what the parity law intended and required in many respects. That particular study focused on the disparity between out-of-network and reimbursement rates between behavioral health and physical healthcare. It showed very clearly there is a huge disparity between those two relative to how much more the care is out-of-network, which puts it at a higher cost for the patient, more difficult to access care, and also the reimbursement rates that are significantly lower for similar services within behavioral compared to physical healthcare. Those are important indicators showing we have a long way to go in truly equalizing mental health and addiction treatment with physical healthcare.

How does that equalization become a reality?

The response is multifaceted. Obviously, enforcing existing laws and regulations is No. 1. Those regulations have not been enforced. That’s something that can be done. We continue to urge the Department of Labor and CMS to be more proactive in that way. In addition, there is legislation pending right now that would require more transparency by health insurance plans, requiring them to document how they are complying with parity, with that available to the public and regulators who can look at these plans to see if they are doing what they say they’re doing. That legislation is pending in the Senate, and we hope it can get through by the end of the year or early next year. Then, I would say the third pillar is litigation and class-action lawsuits. Litigation is another area that will continue to be pursued.

From our organization’s standpoint, we also recognize that we need to engage in dialogue with the health plans and hopefully try to find areas where we can come to some agreement about how best to proceed. All the regulations and laws in the world aren’t going to solve every problem. We do believe more dialogue and engagement with health plans, which we as an organization have been doing and will continue to do, is another avenue that we will continue to pursue.

What should addiction treatment and behavioral healthcare executives focus on in particular with regards to the 2020 election?

The good news is and has been that mental health and addiction issues have been bipartisan. That’s very important in such a polarized Congress and country. The polls and all the evidence shows the American public strongly believes we need to do more to provide access and affordable insurance coverage for those with substance use disorders as well as those with mental illness. That gives us a big platform. The Trump administration has been active on behavioral health issues. They’ve done a lot of things to increase access. The Democrats have proposed numerous plans to improve coverage and access for these treatments. From the standpoint of executives and those who want to be engaged in the political arena is to talk about these illnesses and diseases that are no different than any other medical condition and should be treated as such. It’s not a political issue. It’s a personal issue. We know most people have had some dealings with these illnesses and conditions. It strikes anybody and everyone. We need to continue to get that message across.