By Pamela Greenberg, MPP, President and CEO of the Association for Behavioral Health and Wellness, and James Gelfand, President and CEO of The ERISA Industry Committee.
The Association for Behavioral Health and Wellness (ABHW) and our health plan members who provide mental health and substance use disorder insurance benefits to over 200 million people, and The ERISA Industry Committee (ERIC) with our large employer members who sponsor these and other benefits for tens of millions of employees, their families, and retirees, have been advocates for mental health and substance use disorder parity long before the Mental Health Parity and Addiction Equity Act (MHPAEA) was signed into law in 2008.
MHPAEA is a landmark federal law requiring mental health and substance use disorder benefits and medical and surgical benefits to be treated equally by insurance plans. ABHW and ERIC both played an instrumental role in crafting the negotiated language that became the MHPAEA of 2008, and we remain dedicated to providing equitable coverage of mental health and substance use disorder treatment. In the past 15 years, our respective members have worked tirelessly to implement parity for behavioral health services, innovating new approaches and benefits, working to combat provider shortages and lack of access, and driving quality to improve outcomes for patients.
Since the enactment of MHPAEA, we have consistently sought clarity from regulators on the documentation required for health plans and plan sponsors to demonstrate compliance with parity. And Congress has supported these efforts, calling on the federal agencies more than once to provide more information, illustrative examples, and clear, concise instructions on how to fix parity problems.
However, instead of providing the clarity we have sought, regulators have put forth a new set of proposed rules that, rather than simplifying the process, makes parity implementation and compliance for health plans much more complex. This complexity has the potential to negatively impact health outcomes and quality for patients and increase the cost of care. Instead of celebrating the 15th anniversary of parity this month, we have moved backward on the road to parity.
The new rules propose sweeping changes to current operations, suggesting that parity is viewed as a magic bullet that will solve all the challenges of modern-day behavioral health care. However, no matter how far health plans bend to comply with parity, we will still be left with behavioral health care issues, such as emergency boarding, fragmented care, and a shortage of providers. Focusing solely on parity ignores a multitude of issues that extend beyond the control of employers or carriers, leaving us further behind in making accessible and equitable behavioral health care a reality.
We remain committed to working with regulators to enhance and refine regulations governing parity. However, we have several concerns about the proposed regulation, especially the reinterpretation of the parity statute to subject health plan processes, like prior authorization and concurrent review, to a new analysis that has only ever been applied to financial (e.g., copays, deductibles) and treatment (e.g., day or visit) limits. Health plans have designed these processes to ensure patients receive high quality, medically necessary care. Congress, when enacting MHPAEA, explicitly permitted these processes to ensure safe and effective treatment and prevent significant increases in health insurance costs. Imposing a new quantitative parity analysis on health plan processes is like trying to fit a square peg into a round hole.
Compounding these untenable operations for health plans, the proposed rule provides no appeals process in cases of potential parity non-compliance, unlike other health care compliance processes. Employers and insurers would be stripped of their due process rights. An appeals process is critical to maintaining checks and balances within the system. Without these checks and balances, the entire health care system could be set up for failure, with potential negative impacts on patient health outcomes, service quality, and access to mental health and substance use disorder care.
While the pursuit of parity in behavioral health care is vital, it cannot be viewed as a standalone solution to the complexities that plague the system. The new regulations, while well-intentioned, may bring about unintended negative consequences. We must recognize the large systematic issues that need addressing to truly make a significant impact in achieving parity. A comprehensive approach, extending beyond the narrow confines of parity, is essential. We must focus on broader reforms encompassing access, affordability, and quality improvement. In a time of increasing demand for behavioral health services, it is imperative to tackle these multi-faceted issues head-on, adapting our strategies to create a holistic and responsive system that truly serves the diverse needs of those it aims to help.
If Congress, the federal agencies, and stakeholders like employers, insurers, providers, and consumers work together to address existing problems with parity implementation and access to quality behavioral health care, we can make real strides for patients – just like we did 15 years ago. But right now, the proposed regulation goes in the wrong direction.
