Congress is growing impatient with the Trump administration for not cracking down on insurers that don’t offer affordable mental health and substance abuse coverage.
A bipartisan group of lawmakers recently called for the administration to do a better job of enforcing parity for mental health and substance abuse treatment. The demand comes as Congress tries to pass dozens of bills to combat opioid abuse, with a goal of improving access to addiction treatment.
The Mental Health Parity Act passed in 1996 requires insurers to offer comparable coverage and benefits for mental health and substance use disorders as other medical conditions. For instance, the law requires that insurance coverage for visiting a therapist must be the same as going to a doctor for treating a chronic condition.
A 2008 law expanded on the requirements, and the 21st Century Cures Act of 2016 aimed to improve on the requirements for behavioral health coverage.
The Cures Act required several federal agencies to issue guidance for insurers by December 2017 on how to comply with the law’s parity requirements. It also called for agencies to create an action plan on better enforcement of parity.
But the lawmakers are upset that the Trump administration hasn’t met those requirements as Congress gives renewed attention to mental health and substance abuse parity while the opioid epidemic ravages the country.
So, a group of six senators wrote to the heads of the departments of Health and Human Services, Labor, and Treasury last week urging action.
Lawmakers asked governors and insurance commissioners late last year what the federal government needs to do to help them address the opioid crisis.
“A number of governors and commissioners responded that a federal effort to improve parity compliance and enforcement would be a necessary component of a successful federal response,” the letter said.
Every day, more than 115 people in the U.S. die from an opioid overdose, according to the Centers for Disease Control and Prevention. A major concern has been a lack of treatment options, which led Congress to extend funding to expand treatment in a spending deal last month.
Sens. Lamar Alexander, R-Tenn.; Bill Cassidy, R-La.; Lisa Murkowski, R-Alaska; Patty Murray, D-Wash.; Chris Murphy, D-Conn.; and Debbie Stabenow, D-Mich., signed the letter.
Mental health parity laws extend to insurance coverage on employer-sponsored plans and plans sold on the individual market, which is used by people who don’t have insurance through a job and includes Obamacare’s insurance exchanges. However, some Medicaid plans have to meet some parity requirements.
The original 1996 parity law and subsequent updates have made a major impact on improving access to mental health and substance abuse treatment, advocates say.
For instance, before the 1996 law, there was a lower annual limit on coverage for mental health compared to surgical or medical care. Now, there is no separation.
But consumers have had problems finding affordable mental health and substance abuse treatment despite the laws, according to a November study by the consulting firm Milliman.
Patients went out of network for behavioral healthcare three to six times more than for medical or surgical care, the study found.
Milliman also found out that medical and surgical providers are paid more under insurance plans than behavioral health providers. In 2015, medical and surgical specialists were paid on average 11 to 15 percent more than Medicare-allowed amounts, but behavioral health providers were paid on average nearly 5 percent less than Medicare-allowed amounts.
Primary care doctors were also paid 21 percent more than those in behavioral services, the analysis found. The report looked at medical claims records from major insurers covering 42 million people as of 2015.
Milliman suggested that insurance plans need to look closer at how they pay doctors to ensure compliance with federal law.
Another major problem is barriers to access to mental health or substance abuse care. An example is prior authorization, which requires a patient to receive approval from his insurer before being admitted to a psychiatric hospital.
“It violates parity to the extent they aren’t imposing it for inpatient admission for a cardiac admission or a pulmonary disorder,” said Andrew Sperling, director of legislative advocacy for the National Alliance on Mental Illness.
