Mental Health Parity
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Background on Legislation
Laws designed to put mental health coverage on similar footing with physical health coverage are complex and contain gaps that make true parity difficult to accomplish. Parity legislation at both the state and federal levels for mental health and chemical dependency (MH/CD) date back to the 1990s – predating the Affordable Care Act – and are rooted in separate regulations and statutes. In 1996, Congress passed the Mental Health Parity Act (MHPA), which prohibited large group health plans (plans with more than 50 employees) from applying annual or lifetime dollar limits to mental health benefits that were lower than dollar limits for medical and surgical benefits
The Complexities of Parity
Despite decades of statutes and regulations, the complexities and gaps of current parity laws, combined with ineffective enforcement, have allowed most large group health plans and insurers to continue with business as usual. Federal law does not require large employer groups to cover mental health and chemical dependency services and state mandates primarily reach only fully-insured plans. In addition, it is possible for group health plans to “appear” to be in compliance with parity laws by adjusting their plan designs, when the real world application of non-quantitative treatment limits such as utilization review and medical necessity determinations result in more frequent denials for MH/CD inpatient levels of care than those for inpatient medical care.
In addition, collaborative care interventions, which have been shown to uniquely enhance MH/CD treatment outcomes and reduce unnecessary costs, are not commonly reimbursed by benefit plans. While some testimony indicated that plans are investing in this approach, MMHPI is not aware of any availability in markets we have examined closely (e.g., Dallas County).
Read or download supplemental material provided to the House Select Committee on Mental Health Parity in June 2016.
Additional Reading
In the 85th Legislative Session, Representative Price (R-Amarillo) and Senator Zaffirini (D-Laredo) teamed up to pass HB 10, which expanded the state’s parity enforcement authority to ensure that mental health coverage is treated the same as physical health coverage. Effective September 1, 2017, HB 10 also required the Texas Department of Insurance (TDI) to conduct a one-time data collection and report assessing mental health parity, specifically related to non-quantitative treatment limitations.
Read or download the full report from Texas Department of Insurance Study of Mental Health Parity to Better Understand Consumer Experiences with Accessing Care.
Also effective September 1, 2017, HB 10 required the Health and Human Services Commission (HHSC) to conduct a study and prepare a report comparing benefits provided by Medicaid managed care organizations (MCOs) for medical and surgical expenses to those for mental health and substance use disorder (SUD).
Read or download the full report from Texas Health and Human Services Commission Report to Assess Medical or Surgical Benefits, and Benefits for Mental Health and Substance Use Disorders.