Persistent gaps seen in mental health parity enforcement: Report

Payers are making strides in addressing disparities around mental health and substance use disorder care services but are still falling short of achieving parity under the Mental Health Parity and Addiction Equity Act, according to a Jan. 17 report to Congress from HHS, and the Labor and Treasury Departments.

Five notes:

1. The Employee Benefits Security Administration oversees 2.6 million private health plans,  801,000 retirement, and 514,000 welfare benefit plans covering 156 million workers and retirees. The agency has one investigator per 13,900 plans.

2. Noncompliance is widespread among health plans, and investigations often require techniques such as depositions and claims reviews​. ​Enforcement tools such as settlements, audits, and public awareness campaigns used in 2023 impacted more than 7.6 million enrollees across 72,000 health plans. The enforcement tools were disproportionately used to target restrictive provider networks or overly stringent prior authorization policies.

3. In 2023, approximately 60 million Americans, or 23% of adults, experienced some form of mental illness, and 77% with substance use disorders needed but did not receive treatment. Among minors aged 12-17, more than 18% reported major depressive episodes and 12% experienced suicidal thoughts.

4. Persistent issues with network adequacy and "ghost networks" are apparent, with many listed providers not accessible to patients.

5. The ERISA Industry Committee filed a lawsuit in federal court in January aiming to block new rules requiring tougher mental healthcare requirements for insurers and employers. The rules, finalized by the Biden administration in September, bar insurers from implementing more restrictive prior authorizations on mental health and substance use services than those for medical services. The rule also requires health plans to ensure the outcomes of their mental health coverage policies are equal with those for other forms of care. 

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