Mental health parity: How do we get there?

On the same day that the Departments of Labor, Health and Human Services, and the Treasury issued a report to Congress suggesting that health plans and health insurance providers are failing to deliver parity for mental health and substance-use disorder benefits to those they cover, The Leapfrog Group hosted a webinar offering advice for complying with the latest amendments made to the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

“Access to mental and behavioral health support is critical as the COVID-19 pandemic continues to impact so many lives across the country,” U.S. Secretary of Health and Human Services Xavier Becerra said in a statement. “Unfortunately, as today’s report shows, health plans and insurance companies are falling short of providing access to the treatment many working families need. We are committed to working with our federal partners to change this and hold health plans and insurance companies accountable for delivering more comprehensive care.”

Doing so, however, has become even more challenging for employers and providers — thanks to the Consolidated Appropriations Act of 2021, which created new requirements for group health plans to ensure compliance with the MHPAEA. The MHPAEA prohibits group health plans that offer mental health and substance abuse benefits from imposing less favorable benefit limitations on those benefits than on medical and surgical benefits.

The Jan. 25 webinar focused on those latest CAA changes. Under the CAA, group health plans and issuers are now required to formally analyze and document their compliance, as well as make that data available to the regulator of the plan. Regulators are required to request no fewer than 20 comparative analyses per year.

“This is an insanely complicated law,” James Gelfand, executive vice president of The ERISA Industry Committee, said, noting that the Department of Labor has begun affirmatively auditing employer plans rather than simply waiting for complaints.

“Parity analyses should, in theory, have already existed,” Gelfand said via a series of slides presented during the webinar. “Vendors assure plan sponsors that limitations in their plan are in compliance with [Mental Health Parity Act] rules. But how can that be, if parity analyses have not been conducted? So, while employers traditionally have not necessarily possessed or reviewed this information, DOL’s position is [that] it should be possible to instantly come into compliance.”

Compliance tips

As Lee Lewis, chief strategy officer and general manager of medical solutions for the Health Transformation Alliance, summarized during the webinar, “According to the DOL, no employer today is in compliance.”

Lewis offered three suggestions to help employers move closer to MHPAEA compliance:

1. Understand the attributes of your medical health and mental health plans, and identify gaps.

For example, are wait times for access to mental behavior services the same as they are for access to key medical specialties? Is reimbursement discrimination happening regarding medical claims vs. mental health claims? Are denial of service rates similar in both areas?

2. Protect mental health benefits against “bad actors.”

This has emerged as a major concern in recent years, according to Lewis, as out-of-network insurance providers are calling specific carriers and inquiring about plan benefits to determine limits and how much they can charge the health plan — rather than billing a fair price for a service and letting the appropriate benefit apply. This can drive up costs for everyone on the plan. Some companies have simply stopped quoting benefit levels over the phone to out-of-network providers, Lewis said. He recommended employers also consider utilizing a service such as SmartLight Analytics to help reduce fraud, waste, and abuse in health care claims.

3. Change the plan benefit to add in-network benefits for out-of-network behavioral health providers.

This amplifies in-network access and reduces reimbursement discrimination, Lewis said, adding that the approach is becoming more common among employers by enabling people to find providers wherever possible and use them with a more affordable benefit. As he explained in supplementary materials distributed to attendees at the end of the webinar, “we already do something similar in emergency rooms, anesthesiology, radiology, and pathology.

Most of these providers are out of network, so we pay all of them with in-network benefits because otherwise there’s not enough access, which is terrible for members. The same can be said of mental health, where a large portion is [out of network]. In order for us to secure affordable access for members, we are seeing many employers simply pay them with in-network benefits.”