- State insurance departments are at the front line in enforcing federal mental health protections for plan enrollees but have limited resources to do so. As a result, more federal support is needed to ensure robust compliance and equitable access to care, according to a review of state efforts to help patients from the Georgetown University Health Policy Institute.
- Insurer compliance with the Mental Health Parity and Addiction Equity Act of 2008 has been found to be lacking, with problems ranging from failing to submit adequate information to regulators to clear noncompliance, according to the Georgetown report, which was supported by the Robert Wood Johnson Foundation.
- Use of mental health and substance use disorder services fell sharply at the beginning of the COVID-19 public health emergency and has rebounded more slowly than other types of healthcare, the HHS said in July, when it released a roadmap for behavioral health integration.
The United States faces a growing mental health crisis that has been exacerbated by the COVID-19 pandemic. Almost 53 million Americans in 2020 reported being affected by mental illness, according to the HHS.
President Joe Biden has made tackling the country’s worsening mental health crisis a top priority. The HHS roadmap follows a report issued by the agency and the Labor and Treasury departments in January that found health insurers are failing to deliver parity in mental health and substance use disorder benefits for their members.
The MHPAEA prohibits large employer group plans from imposing stricter limits, such as copayments or prior authorization requirements, on mental health and substance use disorder benefits than they do on medical or surgical benefits.
The Georgetown research, which reviewed MHPAEA enforcement in Arizona, Nebraska, Pennsylvania, Virginia and Washington, found that certain treatment limits, such as the use of prior authorization, provider reimbursement and formulary design, are especially difficult for state regulators to assess. States lack time and resources for effective oversight of MHPAEA, the report said.
Lack of awareness among providers and patients about insurers' obligations to provide equal access to mental health services under the federal parity law further hinders enforcement, the researchers found. They argued that states need additional resources to conduct necessary benefits reviews, and several states cite the need for additional federal guidance to strengthen their enforcement efforts.
Areas where states need more support include improving the annual review process by requiring insurers to submit their comparative analyses and conducting targeted reviews, conducting baseline MHPAEA exams on all insurers in the state and using third-party data sources to conduct more narrowly focused and frequent exams.
Acknowledging the impact of the pandemic on mental health, AHIP has said that insurers are committed to promoting parity and improving access to treatment for patients. "Health insurance providers note that while good progress has been made, more needs to be done," the insurance lobby said in a statement released in August.