The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires plans to offer mental health and substance use disorder on terms that are not more restrictive than medical and surgical care.
Lisa Gomez, the former head of the Employee Benefits Security Administration (EBSA), explains that the main premise of MHPAEA is “no one should have to face greater barriers in trying to access care for a mental health condition or a substance use disorder than you would for a medical condition or for surgery.”
Gomez says that additional barriers can include facility access, such as a plan that restricts access to in-patient care for addiction that they don’t have for surgical care.
Joe Feldman, the president of Cover My Mental Health says that for plans “there is an obligation to be comparable” in their coverage of mental health and substance use on one side, and medical and surgical on the other.
Feldman explains that plans must have parity on NQTLs, or non-quantitative treatment limitations, which can include restrictions such as fail-first approaches or step therapy rules that are not applied equally.
Deborah Steinberg, a senior health policy attorney at the Legal Action Center, notes that there are “rampant exclusions in a lot of plans” such as age-based exclusions and the difficulty of accessing mental health providers.
One common compliance issue that Steinberg highlighted was plans that cover medications but don’t cover substance use disorder medications to the same extent, such as those that treat opioid dependency.
Steinberg emphasizes that parity is important because ‘there was all of this discrimination in insurance plans” prior to the MHPAEA, and that discrimination “led to mental health and substance use disorders being stigmatized and discriminated against.”
“These are health conditions” she adds, “and “treatment allows them to be productive members of their families and workforce.”
“We can’t reduce that stigma if we can’t treat these conditions as the health conditions they are.”
Role Of EBSA
Apart from enforcement, EBSA has also raised awareness of parity requirements. Gomez says that for so long people had been accustomed to not having coverage for mental health and so EBSA launched a “very aggressive outreach campaign” to inform the public.
EBSA also has a hotline to help participants and plans understand their rights and issue FAQs and other guidance for plan sponsors.
Gomez says that near the end of her tenure at EBSA, that EBSA was preparing a self-compliance tool to help sponsors evaluate plans for compliance. Such a tool was widely requested by sponsors. Staff cuts at EBSA will compromise its ability to issue this tool.
Even before recent cuts to EBSA’s staffing, they didn’t “have all the tools to effectively enforce parity,” Steinberg says, “we are very worried that this will set us back very far.”
