6 Strategies for Enforcing Mental Health Parity Now

The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 gave those of us who work on the front lines of behavioral health a glimmer of hope. Finally, patients who so desperately needed treatment would be able to access life-saving care—or so we believed.

The reality has not been so hopeful. With virtually no enforcement, and many health plans and insurers unwilling to voluntarily comply, there’s been very little progress in eliminating the disparity between mental and physical healthcare coverage. While the Consolidated Appropriations Act of 2021 aimed to give the parity act some teeth, it’s become clear with the January 2022 MHPAEA Report to Congress that none of the plans and insurers asked to validate their compliance were able to do so sufficiently.

This is patently unacceptable. Given the recent surge in mental health challenges and the record number of overdose deaths—more than 100,000 lives lost—during the pandemic, it’s time we make enforcing MHPAEA an urgent priority.

It would be easy to lay responsibility for compliance squarely at the feet of insurers. However, all of us in the healthcare ecosystem—insurers, regulators, providers and even patients—play a role in enforcing coverage parity. Here’s how we can all work together to ensure people get the treatment they need.

Plans must integrate their physical and mental health coverage. At some point during the genesis of our current healthcare system, the head was surgically removed from the body. For years, we treated mental and physical health independently, and insurers mostly outsourced mental health programs to carve out companies, perpetuating this bifurcation of behavioral and physical health. Quite literally, their IT systems couldn’t make the connection, resulting in silos.

We now know there’s a deep and demonstrable connection between the mind and body, and we as providers recognize we must treat patients holistically. But plans must also take a holistic approach, connecting, coordinating and integrating data to analyze the interplay between physical and mental health. This will allow them to see, in real dollars, how addressing behavioral issues—or failure to—impacts spending and utilization.

Providers can help by offering supportive evidence to demonstrate impact. Plans need proof that successfully treating mental health conditions and substance use disorder will benefit their bottom line. By conducting patient outcome studies, providers can demonstrate the ROI of treating behavioral health and addictions on overall health and spending. We know that patients who get treatment do a much better job of managing chronic health issues like diabetes and high blood pressure, reducing emergency room visits and hospital utilization as a result.

By designing best practices for care and standardizing outcome metrics, providers can demonstrate what success looks like. Then, by tracking outcome data and providing this to insurers, we as treatment professionals can prove that coverage of behavioral health is a smart financial decision. It’s simply less expensive to keep members holistically healthy.

Plans can use parity as a competitive differentiator. As COVID has exacerbated mental health and substance use issues, both individuals and employers who make health plan decisions have become more aware of the need for mental and behavioral health services. The market not only recognizes the need for parity but also the rationale behind a holistic approach to wellness.

Insurers and health plans would be wise to voluntarily step up compliance with MHPAEA as a competitive differentiator. By showcasing their integrated physical/mental health programs, the priority they place on holistic wellness, and publicizing their quality indicators—both non-quantitative treatment limitations (NQTLs) and quantitative treatment limitations (QTLs)—as part of their accreditations, they could attract new business with their progressive approach.

Agencies and the media must hold plans accountable with penalties and publicity. While one could hope the carrot is all that’s needed to entice compliance, it may require a bit of the stick to get the ball rolling. We’ve heard promises of financial penalties for noncompliance, but that has yet to happen—in fact, there’s been virtually no response at all.

The Departments of Labor and Health and Human Services have a responsibility to enforce the law and hold plans financially accountable for failure to deliver the parity and equity it mandates. At the same time, media outlets should cover these violations and failures, casting light on plans that don’t adhere to MHPAEA, as well as giving ample coverage to the benefits of doing so.

Providers should report—and encourage patients to report—noncompliance. Most patients are unaware of MHPAEA and their insurers’ responsibilities under the law, so when they experience treatment denials, disparate co-pays or excessive medical necessity criteria, they don’t realize they do have recourse.

When these violations happen, providers should report noncompliance to their local health boards, state insurance commissions/departments of managed care, and departments of labor and encourage patients to do the same. By empowering patients to advocate for their own benefits coverage and healthcare, this in turn holds insurers accountable not just to Congress, but to their customers—their covered members—who may choose to take their premium dollars elsewhere.

We must work together to expand access to care. Full MHPAEA compliance still won’t solve the supply/demand problem in behavioral health. Already there are far more people who need and seek treatment than there are resources to provide it, especially in rural communities. We, as an industry, must work together to expand access to care.

That means encouraging utilization of and access to telehealth, resolving licensing issues that restrict providers from practicing telemedicine across state lines, and removing reimbursement barriers that prevent providers (like nurse practitioners, physician assistants, etc.) to practice at the top of their license.

While MHPAEA legally affects only health plans and insurers, it broadly impacts the entire healthcare ecosystem. Now more than ever, with thousands of lives lost and untold thousands more in jeopardy, we must all advocate for strict enforcement to ensure patients get the care they need.

Lawrence Weinstein, MD, is chief medical officer for American Addiction Centers.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.