• Feds Unveil New Resources on Mental Health, SUD Coverage

    May 17, 2022, 1:50 p.m. News Staff — HHS, in partnership with the Department of Labor, has published a series of free resources to make Americans aware of their rights to coverage of mental health and substance use disorder benefits through protections offered under the Mental Health Parity and Addiction Equity Act.

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    Also known as the Parity Law, MHPAEA was passed in 2008. While the law does not require health insurers to provide mental health and substance use disorder benefits, in general it prevents group health plans and health insurers that do offer such benefits from imposing less favorable limitations for mental health and SUD services than on coverage limits for medical and surgical benefits. Some of the more common limitations include higher out-of-pocket costs, network inadequacy, excess prior authorization requirements and “fail first” requirements that delay effective treatment.

    “Since 2008, the Parity Law has required many group health plans and health insurance issuers that provide access to and coverage of mental health conditions and substance use disorders to do so on equal footing with physical health needs, yet many insurance providers continue to fall short in this area,” said HHS Secretary Xavier Becerra in a press release. “We must do more to promote the needs and rights of the populations we serve — every person living in America should have access to equal coverage of these life-saving services and supports.”

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    Three new resources are available on the Substance Abuse and Mental Health Services Administration website:

    “The full implementation of parity is essential to ensuring a healthy future for Americans,” added Miriam Delphin-Rittmon, Ph.D., assistant secretary for mental health and substance use at HHS and SAMHSA’s administrator. “It is vital for people to understand that insurance companies covering mental health and substance use conditions must do so as they would other medical conditions, and to understand the steps consumers can take to seek redress if the requirements of the law are not being met.”

    The new materials come on the heels of a congressional report from HHS and the Departments of Labor and the Treasury which recommended, among other things, that Congress consider amending the Parity Law to ensure that mental health and substance use disorder benefits are objectively and uniformly defined with external benchmarks that are based in nationally recognized standards, and to permanently expand access to telehealth and remote care service so health care professionals can continue providing behavioral health care in this manner.

    The AAFP advocates to improve parity for mental health services, including for non-quantitative treatment limits like prior authorizations and step therapy requirements. The Academy’s recent letter to CMS on Medicaid access highlighted that mental health parity enforcement should also expand to include more specific access standards, as well as oversight and monitoring of mental health access metrics by CMS.

    The AAFP also recently submitted testimony to the Senate Finance Committee that highlighted recommendations for better parity enforcement, like authorizing the Department of Labor to levy fines for parity violations. In addition, the Academy has endorsed legislation that would reduce cost-sharing for preventive screenings, including depression, and streamline prior authorization and step therapy requirements in Medicare Advantage.