Breaking Down Barriers to Mental Health Parity in Disability Plans
By Teri Weber, SVP, Spring Consulting Group
Employee well-being and engagement have been front and center for the last two years. Employers have been trying to focus on their employees’ mental health in the face of unprecedented stress and anxiety prompted in some cases by a global pandemic. The original worries and unknowns were exacerbated by personal isolation, delayed medical services, and the burden of heavy emotional labor at home due to potential joblessness, home schooling, and other issues. The initial enjoyment from wearing pajamas most of the day turned into an inability to get out of bed, refuel oneself, and build connections for many people, who felt added pressure and needed additional support.
Smart organizations reacted. They enhanced networks, expanded virtual services, and found new partners to fill voids. Through targeted action they reduced mental health stigma, increased access to care, and decreased barriers to behavioral health services to build greater mental health parity.
The concept of mental health parity is not new. The Mental Health Parity Act, which was originally passed in 1996, ensures that large group health plans cannot impose annual or lifetime dollar limits on mental health benefits that are less favorable than limits on medical and surgical benefits.1 And the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 ensures large group health plans and insurers that provide mental health or substance use disorder benefits do not place limits on these services that would not be placed on medical and surgical services.
This cutting-edge legislation opened our minds to the biases embedded in our healthcare system that restricted access to behavioral health services. Fast forward to the 2010 Patient Protection and Affordable Care Act (ACA) and required additional parity with individual and group health plans. A full decade later the Consolidated Appropriations Act (CAA) is forcing us to examine quantitative considerations and nonquantitative treatment limitations (NQTLs), which go beyond the high-level plan design features and require health plans to compare up to 216 unique NQTLs and ensure that sufficient information is available to validate that parity exists related to administration. For example, some areas of heightened concern include billing, pre-authorization and pre-certifications; limitations or exclusions on behavioral analysis therapy; and nutritional counseling or medication-assisted treatment for opioid use disorders.
The timeline of mental health parity legislation shows that progress has been made, but it has been slow and only focused on parity between mental health compared with medical and surgical benefits. This leaves a big gap in other areas of insurance, which maintains the stigma related to mental illness and substance use disorders and results in embedded discriminatory practices and bias.
- 1996 – Mental Health Parity Act
- 2008 – Mental Health Parity and Addiction Equity Act
- 2010 – Affordable Care Act
- 2013 – Mental Health Parity & Addiction Equity Act (Final Ruling)
- 2016 – CMS release non-qualitative guidance.
- 2018 – DOL releases self-compliance tool for employers.
- 2020 – Consolidated Appropriations Act; DOL re-releases compliance tool.
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