A new policy brief from Health Affairs and the Robert Wood Johnson Foundation looks at the issue of enforcing mental health parity five years after the Mental Health Parity and Addiction Equity Act (MHPAEA) took effect. It significantly updates the previous health policy brief on mental health parity, released on April 3, 2014. That brief examined the evolution of the Mental Health Parity Act (MHPA) and changes in mental health parity brought about by the implementation of the Affordable Care Act (ACA). This brief focuses on how MHPAEA is being enforced, a process that has not always been consistent.
Topics covered by this brief include:
What's the background and the law? While the push for mental health parity has a long history, detailed in the 2014 brief, the move for equal benefits on substance use treatment is a newer development. This brief provides background on the passage of the MHPAEA and how it went beyond MHPA, including coverage in Medicare Advantage plans, Medicaid managed care plans, and state Children's Health Insurance Program plans, explaining how coverage is handled by each plan.
What's the debate? According to the brief, many advocates allege that while health plans may appear in compliance with the MHPAEA, plans may use subtle ways to make mental health and substance use treatment less available than treatment for other medical conditions. A National Alliance on Mental Health Illness survey, released this past April, states that 29 percent of patients were denied mental health care based on "medical necessity," compared to 14 percent of patients denied care for other conditions. The brief details the ways several states have taken action against insurance plans for violating the states' mental health parity laws. It also addresses some issues beyond the reach of the MHPAEA, such as why a significant percentage of mental health providers opt not to participate in health plan networks or do not accept insurance at all.
What's next? As the brief notes, it is hard to determine whether plans are using nonquantifiable treatment limitations to avoid compliance with the MHPAEA. With the Department of Health and Human Services still needing to finalize some of the regulations and preoccupied with ACA implementation and enforcement, it is likely that there will be more cases going to court to enforce patients' rights under the MHPAEA.