By Kathryn Cohen
Mental health and substance use disorder benefits should not be subject to more restrictive financial requirements or treatment limitations than medical and surgical benefits. This principle was enshrined in the Mental Health Parity and Addiction Equity Act (MHPAEA), passed in 2008. The Act has been subject to considerable interpretation and revision, as implementation has proven burdensome and confusing for the health plans that are tasked with putting the principle into practice.
As the Departments of Labor, Health and Human Services, and the Treasury develop a new proposed rule implementing MHPAEA that is scheduled to be released near the end of this year, we have an opportunity to create a clearer, more workable regulatory framework—one that strengthens compliance while allowing health plans, regulators, providers, and patients to focus on what ultimately matters: access to high-quality behavioral health care.
Then we must look beyond parity. Parity is a vital step toward a strong behavioral health system. But it is not the end goal. At ABHW, our hopes are for parity and:
- Individualized, evidence-based, patient-centered care
- Consistent standards, evidence-based assessment, and measurable outcomes
- Qualified providers and accountability
- Coordinated, integrated, whole-person care.
Making the parity framework clearer and more effective provides an important foundation for parity and. This requires several critical elements.
Clear, Practical Rules for Compliance Consistent with Statute
The next parity rule should provide clear, workable guidance that aligns with the requirements Congress established in the Consolidated Appropriations Act of 2021 (CAA 21). Health plans need to understand what they must do to demonstrate compliance, and regulators and health plans need consistent definitions and standards for interpreting the law. The rule should clarify longstanding areas of uncertainty, including how nonquantitative treatment limitations should be evaluated.
Just as importantly, the regulatory framework should remain grounded in statute and avoid imposing requirements beyond what Congress enacted. Doing so provides regulated entities with greater clarity and predictability, reduces unnecessary compliance burdens, and allows resources to remain focused on achieving the outcomes of law.
Practical Safe Harbors for Good-Faith Compliance
The new parity rule should establish practical safe harbors for health plans that meet objective standards demonstrating good-faith parity compliance.
These could include, for example, expanding behavioral health provider networks, demonstrating that prior authorization practices for behavioral health services are no more restrictive than comparable medical and surgical practices, or meeting defined performance benchmarks.
Safe harbors would not weaken parity. Properly designed, they could strengthen implementation by providing greater clarity and consistency around what effective compliance looks like, while encouraging investments and practices that expand access to high-quality behavioral health care.
A Fair and Transparent Appeals Process
Parity enforcement should include a meaningful opportunity for plans to respond to and appeal significant findings before substantial enforcement actions are taken.
MHPAEA compliance can involve complex legal, clinical, and operational questions. A transparent process for reviewing disputed findings would help ensure that enforcement decisions are based on consistent interpretations of the law and a complete understanding of the relevant facts. A fair appeals process benefits the entire system by improving consistency, transparency, and confidence in the enforcement of parity.
Parity and… Working Together on What Comes Next
These reforms share a common goal: a parity framework in which expectations are clear, compliance is achievable and measurable, and enforcement is consistent and fair.
But getting parity right is only part of the work ahead. The challenges facing the behavioral health system extend well beyond MHPAEA. Workforce shortages, gaps in access, fragmented care, inconsistent quality measurement, and the need for greater integration of behavioral and physical health care require broader solutions, and collaboration across health plans, providers, policymakers, patients, and other stakeholders.
That means working together toward parity and quality. Parity and measurable outcomes. Parity and an appropriately qualified workforce. Parity and integrated, whole-person care.
MHPAEA remains a vital part of that work. A clearer, more practical regulatory framework can strengthen compliance while allowing health plans and regulators to direct greater attention toward the broader reforms necessary to build a behavioral health system that works better for patients.
