Federal Parity Task Force Takes Steps to Strengthen Insurance Coverage for Mental Health and Substance Use Disorders
For too long, Americans paid for health insurance that did not recognize that treatment for mental health and substance use disorders is as essential as other medical treatment. Untreated mental health and substance use disorders can be debilitating and life-threatening. These consequences are apparent in the prescription opioid and heroin epidemic, as well as the troubling rates of suicide and severe mental illness in this country.
One of the many important provisions of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act is to ensure that health insurance plans treat mental health and substance use disorders the same way that they treat other health conditions. In March of this year,
Today in its final report, the
These steps are based on input the
Today, the
* The
* The
* The
* DOL is announcing that it will release annual data on closed Federal parity investigations and will report on the findings, including the violations cited to ensure parity compliance and inform future policymaking efforts. This effort builds on the 1,515 investigations related to the Mental Health Parity and Addiction Equity Act and 171 violations cited by DOL since October of 2010.
* To ensure parity compliance in plans required to offer essential health benefits, CMS has added Mental Health Parity and Addiction Equity Act compliance to its review of plans subject to the essential health benefits requirement under the Affordable Care Act, and it expects State regulators to do so as well.
* DOL, HHS, and the
* HHS, DOL and
* SAMHSA is announcing that it will host two State Policy Academies on Parity Implementation for State Officials in Fiscal Year 2017, including one focused on the commercial market and one on parity in
* CMS will undertake a review of mental health and substance use disorder benefits in
* DOL, HHS, and
In addition, the
* Create a one-stop consumer web portal to help consumers navigate parity, which will build out the functionality of the beta parity website released today. The Task Force recommends that the website should help consumers solve coverage issues, file a complaint, or submit an appeal, and also be used to better inform parity oversight and enforcement efforts.
* Increase Federal agencies' capacity to audit health plans for parity compliance. The Task Force recommends that agencies' future budgets include funding to expand audit capacity. Given current resources, Federal parity enforcement efforts to date have generally focused on investigating consumer, provider and other parity complaints. Agencies' capacity to expand enforcement activities, including conducting random audits, is limited by their staffing resources.
* Undertake a detailed review of the non-quantitative treatment limits applicable to substance use disorder benefits in the Federal Employees Health Benefits (FEHB) Program. The Task Force received comments suggesting that non-quantitative treatment limits in FEHB plans may need examination and modification to ensure full compliance, as well as comments suggesting that consistent definitions of terms relating to residential treatment would provide greater transparency for consumers.
* Allow the
* Develop examples of parity compliance best practices and of potential warning signs of non-compliance. Building on the 2016 DOL/HHS "Warning Signs" document identifying non-quantitative treatment limitations that require additional analysis to determine if they are in compliance with parity, the
* Provide Federal support for State efforts to enforce parity through trainings, resources, and new implementation tools, including model compliance templates. The Task Force recommends continued Federal efforts to provide training and other resources to States to support compliance efforts including partnerships between State mental health/substance use,
* Provide simplified disclosure tools to provide consistent information for consumers, plans and issuers. To facilitate disclosure, the
* Expand consumer education about parity protections. The Task Force recommends continuing and expanding the work to educate consumers about parity and partnering with consumer groups to increase consumer awareness and understanding of parity protections.
* Clarify that health plan disclosure requirements include medical and surgical benefits. The Task Force heard from commenters that it can be challenging to ensure parity compliance when information on medical and surgical benefits is not readily available to allow for comparison to mental health and substance use disorder benefits. Disclosure of the relevant information used to apply coverage limitations to medical and surgical services is currently required for plans covered under the Employee Retirement Income Security Act (ERISA). The Task Force recommends that
* Implement the
* Expand access to mental health and substance use disorder services in TRICARE. The Task Force recommends the
* Eliminate the lifetime day limit on Medicare Part A treatment in psychiatric hospitals. In Medicare Part A (hospital coverage), there is a 190-day lifetime limit on inpatient treatment in psychiatric hospitals while there is no such limit on inpatient medical/surgical hospital treatment. The Task Force recommends that
* Update guidance to address the applicability of parity to opioid use disorder services. The Task Force recommends issuing guidance clarifying the application of parity to opioid use disorder treatment benefits in response to specific scenarios associated with these benefits raised by consumers and other stakeholders and updating this guidance regularly, as warranted.
* Eliminate the parity opt-out process for self-funded non-Federal governmental plans. Currently, self-funded non-Federal governmental plans have the ability to elect to not comply with certain Federal provisions including the Mental Health Parity and Addiction Equity Act, which deprives thousands of employees of State and local governments of the mental health and substance use disorder parity protections. The Task Force recommends that
These recommendations are subject to future budget and policy deliberations. Together, today's steps build on the ongoing work of the Administration to make the treatment of mental health and substance use disorders a priority. The Affordable Care Act ended insurance discrimination based on pre-existing conditions, including mental health and substance use disorders; required coverage of mental health and substance use disorder services in non-grandfathered plans 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
Through these steps, the country has made significant progress in expanding mental health and substance use disorder coverage and parity protections for millions of Americans. The Task Force report focuses on parity-related actions and recommendations and does not include the provisions in the President's Budget that would further expand access to care, including new investments in treatment capacity. The actions and recommendations announced today will continue to advance the Administration's progress on parity implementation.
The full report is available here: http://www.hhs.gov/parity
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