Industry Reacts to Report on Payer Mental Health Parity Compliance

Healthcare stakeholders are responding to the 2022 Mental Health Parity and Addiction Equity Act (MHPAEA) Report, with the American Medical Association (AMA) releasing a statement saying that this report exposes insurers’ unwillingness to abide by mental health parity compliance regulations.

“This report underscores two simple facts: insurers will not change their behaviors without increased enforcement and accountability, and patients will continue to suffer until that happens,” James L. Madara, MD, chief executive officer of the AMA, wrote in a letter to the chairman and ranking member of the House Committee on Ways and Means.

The congressional report, published on January 25, 2022, reviewed payers' comparative analyses, assessed compliance, and made recommendations about how to amend the process in order to better enforce parity compliance among healthcare payers. The report found many payers' analyses to be insufficient.

In response, AMA called on Congress to enact the Parity Implementation Assistance Act (HR 3753/S 1962). The law would offer grants to enable financially support states' efforts to check payers’ comparative analyses of mental health and substance use disorder non-quantitative treatment limitations.

The association also recommended that the Department of Labor be vested with the authority to assign financial penalties to health insurers who fail to comply with the mental healthcare parity policies.

AMA supported changing the Employee Retirement Income Security Act (ERISA) to allow individuals who were denied eligible mental health treatment coverage to receive compensation.

Additionally, payers should be required to do a prospective analysis of their mental health compliance, according to the AMA.

“Requiring prior comparative analysis can help streamline oversight, can help payers identify gaps, and most important—may help ensure patients have the coverage required by the law,” the letter explained.

However, compliance enforcement cannot stop at in-person care.

AMA noted that Congress should address parity compliance with regards to telemental healthcare as well as remote patient monitoring and care. As part of the effort to protect compliance in these areas, AMA recommended enacting the Telemental Health Care Access Act (HR 4058/S 2061).

If Congress fails to act, the letter emphasized the impact that insurers’ lack of compliance can have on members, citing numbers from the congressional report. 

For example, self-funded plans’ exclusion of evidence-based treatment for individuals with autism can have a negative impact on the development of children on the autism spectrum.

Plans that excluded medications for medications to treat opioid use disorder and prior authorizations for mental healthcare treatment can establish barriers to care, as demonstrated during the coronavirus pandemic. 

Health plans also denied coverage for access to nutritional counseling for mental healthcare needs, despite covering counseling for other conditions that were not related to mental health.

Payers have responded by underscoring their support for mental healthcare and by reiterating their demands for more clarity around compliance protocols.

“Mental health care is health care, and we take our members' mental health needs seriously,” Kris Haltmeyer, vice president of policy analysis for the Blue Cross Blue Shield Association, told HealthPayerIntelligence in an emailed interview.

However, Haltmeyer found that the laws meant to protect members’ mental healthcare coverage—specifically, MHPAEA—needed clarification.

“The report itself admits there’s ‘great latitude’ in what’s subject to parity, which leads to non-uniform, subjective determinations, and different standards for parity from plan-to-plan,” Haltmeyer pointed out. 

“We have long advocated—and continue to do so—for the administration to provide more clarity around what constitutes compliance and better support to assist with compliance. We are committed to complying with the law and will continue to work with the administration to provide Americans with the mental health care they need and deserve.”