Testimony for the new federal parity task force

(Author's Note:: On April 25, I was part of a group invited to the White House to give testimony to select White House staff and lead staff from the U.S. Department of Health and Human Services and the Department of Labor. The purpose of this testimony was to provide background for a task force created recently by President Obama to make recommendations by October 16, 2016, on next steps in implementing the Mental Health Parity and Addiction Equity Act of 2008. This is the testimony I submitted in writing.)

My name is Ron Manderscheid, PhD; I am the Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors and the National Association for Rural Mental Health. I also am the co-Chair of the Coalition for Whole Health. I greatly appreciate the opportunity to provide input for the new Parity Task Force.

As background, we strongly support the Parity Act and its full implementation and enforcement. This legislation has played a pivotal role in positioning behavioral health for inclusion in the Affordable Care Act (ACA), and it has changed the dialogue around behavioral health in both the insurance and healthcare fields.

Now, we believe that it is very timely for the federal government to assure that this legislation is implemented broadly. Currently, many insurance companies offering health insurance in the field do not provide sufficient information to determine whether plans are compliant with parity. Similarly, many insurance consumers are not knowledgeable about parity or about what they should do if they discover a parity violation. For several years, the Kennedy Forum has been documenting these problems at the state level, and recent research published by staff at Johns Hopkins University supports these observations.

The question is: What steps should federal government take?

We recommend that three primary steps be taken:

> TECHNICAL ASSISTANCE AND TRAINING. We recommend that the federal government engage in both technical assistance and training around the parity requirements for commercial health insurance. Technical assistance should be focused on state health insurance commissioners, state health and behavioral health commissioners, insurers themselves, and the national associations that represent insurers, among others. This technical assistance should be very practical and demonstrate by clear examples compliant and non-compliant quantitative and qualitative treatment limitations. Training should be provided to the public at large to raise awareness regarding parity, with some concrete examples, and definition of a clear path for reporting parity violations. When violations are reported, corrective action should be taken.

> MONITORING OF INSURANCE PLANS. On a universal basis every year, commercial insurance plans should be required to provide written assurance that each plan offered is fully compliant with parity requirements. In addition, insurance plans should be required to provide written documentation that supports the written assurance. The Centers for Medicare and Medicaid Services is using a similar approach to assure state compliance with Medicaid managed care parity requirements, just announced recently.

> ENFORCEMENT. In collaboration, the federal and state governments need to enforce parity requirements. When violations are reported or noted, a corrective plan should be required. If the violations persist, plans should be debarred from offering health insurance in the state where the violations occurred, and appropriate civil and/or criminal penalties imposed.

It does little good to have parity legislation on the books if it is not implemented and enforced.

I also want to leave you a copy of an in-press publication that Dr. John Bartlett and I prepared on the effects of parity for adults with serious mental illness.*

Thank you again for affording me the opportunity to testify on this very important topic.

We will look forward to the findings and recommendations of the task force.

*Bartlett, J. and Manderscheid, R., “What does mental health parity really mean for the care of people with serious mental illness?” Psychiatric Clinics of North America (2016), in press.