Health benefits

Health plans fail to offer parity for mental health benefits

A January 25 report by the Departments of Labor, Health and Human Services and Treasury, 2022 Report to Congress on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAE), found that Health plans and health insurers do not offer parity for mental health and substance use disorder benefits to those they cover.

“The report’s findings make it clear that health plans and insurance companies are failing to provide parity in mental health and addictions benefits, at a time when these benefits are needed like never before,” said US Secretary of Labor Marty Walsh. “The pandemic is negatively impacting the mental health of people in the United States and leading to increased substance use. As a person in recovery, I know firsthand how important access to treatment for mental health and addictions disorders is. Enforcement of this law is a top priority for the Department of Labor and a goal that I take personally.

Equal coverage conditions

In general, the MHPAEA requires that financial requirements and treatment limitations – such as copayments and prior authorization requirements imposed by a group health plan or health insurance issuer on mental health benefits or substance abuse – cannot be more restrictive than the prevailing financial demands and treatment. limitations that apply to almost all medical and surgical services. The report cites specific examples of health plans and health insurance providers that do not provide parity. For example, one health insurance issuer covered nutrition counseling for medical conditions such as diabetes, but not for mental health issues such as anorexia nervosa, bulimia nervosa, and binge eating disorder.

“Access to mental and behavioral health support is critical as the COVID-19 pandemic continues to impact so many lives across the country,” said the US Secretary of Health and Human Services. social Xavier Becerra. “Unfortunately, as today’s report shows, health plans and insurance companies are failing to provide the access to treatment that many working families need. We are committed to working with our federal partners to change that and hold health plans and insurance companies accountable for providing more comprehensive care.

New application tool

The report outlines departments’ efforts to interpret, implement, and enforce the changes made to the MHPAEA by the Consolidated Appropriation Act of 2021. The act provided departments with an important new tool for enforcing the MHPAEA and additional funding to implement it. The law also requires departments to report their findings under this new provision annually. Today’s release is the first report under this requirement.

“Over the past year, the Employee Benefits Security Administration has focused on ensuring parity for mental health and addictions benefits,” said the Acting Assistant Secretary for employee benefits security, Ali Khawar. “As we continue to strengthen and grow these efforts through regulation, enforcement and compliance assistance, EBSA is committed to delivering on the promise of the law.”

The report also details the ministries’ ongoing efforts to engage with stakeholders to reduce the stigma that people with mental health or addictions issues often face and to educate stakeholders about these vital protections.

The MHPAEA Enforcement Fact Sheet for Fiscal Year 2021 is published with the MHPAEA’s 2022 Report to Congress. This fact sheet highlights EBSA’s landmark settlement against United Behavioral Health, as well as other important enforcement data and findings from MHPAEA investigations closed by EBSA and CMS during the fiscal year 2021.

EBSA has primary enforcement jurisdiction over the MHPAEA for approximately two million health plans covering approximately 136 million Americans. CMS has enforcement jurisdiction over the MHPAEA in individual and fully insured group markets in the states where it has enforcement authority and over non-federal government group health plans, such as plans sponsored by the governments of the States and locals for their employees.