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Report Details Health Plans’ Shortcomings in Parity Compliance
Since the passage of the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008, implementing its laws has been “a work in progress,” US Secretary of Labor Marty Walsh told reporters in a conference call on Tuesday.
Walsh said the Biden administration wants to ramp up enforcement of the parity laws, but a report issued by the US Departments of Labor, Health and Human Services (HHS), and Treasury indicate a significant amount of work remains. Information in the report shows health plans and health insurers are failing to deliver parity for mental health and substance use disorder (SUD) benefits for those they cover. The report also covers how parity laws are being enforced, guidance to correct failures, and recommendations for strengthening consumer protections and departments’ enforcement abilities.
“Although progress has been made, there is so much more that needs to be done,” said Acting Assistant Secretary for Employee Benefits Security Ali Khawar, who added that parity for mental health and addiction treatment coverage has been an issue that has received bipartisan support from federal legislators.
>> READ the 2022 MHPAEA Report to Congress
The Consolidated Appropriations Act of 2021 provided a new enforcement tool: Health plans and issuers must now provide comparative analyses of their nonquantitative treatment limitations (NQTLs) to the secretaries of the Labor, HHS, and Treasury on request to confirm MHPAEA compliance.
The Employee Benefits Security Administration (EBSA) has issued 156 letters requesting comparative analyses for 216 unique NQTLs across 86 investigations. Between May and November 2021, the Centers for Medicare and Medicaid Services (CMS) issued 15 letters to issuers where CMS has direct enforcement authority over parity compliance (Texas, Missouri, and Wyoming) and to non-federal government plan sponsors in those and other states.
Per the report issued on Tuesday, none of the comparative analyses reviewed have contained sufficient information on initial receipt. EBSA and CMS have sent letters detailing various insufficiencies, such as mental health and SUD benefits lacking parity with medical/surgical benefits and NQTLs having impermissible separate treatment limitations. To date, 26 plans and issuers have agreed to make prospective changes to their plans.
Coverage of applied behavior analysis (ABA) therapy for autism was a common problem area for plans and issuers, with ABA therapy facing a blanket exclusion, Khawar said. In the context of the COVID-19 pandemic, the mental health of children and adolescents has been a particular concern, Khawar said. He noted that several studies demonstrate the importance of ABA therapy and that receiving treatment earlier can lead to dramatic differences later in life; thus, making coverage of therapy for autism a point of interest for regulators.
In addition to coverage for ABA therapy, the report provided several other recent examples of parity enforcement. In one instance, a large, self-funded Taft-Hartley health plan covering 7600 participants specifically excluded methadone and naltrexone as treatment for SUD—an impermissible restriction, as the plan did not place similar restrictions on medications for medical/surgical conditions or have a sufficient comparative analysis describing its process for creating the exclusion. EBSA’s Boston Regional Office is now working with the plan to identify affected participants and take corrective action.
Similarly, a pair of large plans were found to cover nutritional counseling for medical/surgical conditions, such as diabetes, but not mental health conditions, such as anorexia nervosa, bulimia nervosa, or binge-eating disorder. The discrepancy was identified by EBSA’s New York Regional Office, which is now working with the plans to take corrective measures.
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