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Taking much-needed action on parity

October 28, 2016

Parity, a small word with huge implications, received broad support this week. This week, President Obama’s Mental Health and Substance Use Disorder Parity Task Force issued its final report. A day earlier, former congressman and parity legislation author, Patrick Kennedy, convened the Kennedy Forum in New York City to take stock of the Forum’s work to accelerate parity implementation and to plan the next steps in its efforts.

As background, the Mental Health Parity and Addiction Equity Act became law originally in 2008. This legislation requires that large (50 or more enrollees) private health insurance plans that offer mental health and substance use disorder benefits must offer them at parity with medical benefits and must not manage these benefits more stringently than medical benefits.

The Affordable Care Act of 2010 extended these protections to all health insurance offered through the state health insurance marketplaces, all health insurance offered through individual and small group plans, and all health insurance offered through the state Medicaid expansions. Today, it is estimated that more than 84 million Americans have parity protections in their health insurance.

However, eight years after the passage of the original legislation, numerous heart-wrenching reports of parity violations by insurance companies continue to document that many of these plans actually do not provide these fundamental protections. Further, the majority of health insurance purchasers are either unaware of these protections or, if aware, do not really understand how they operate. These urgent concerns became the basis of President Obama’s Executive Order on Parity and of Patrick Kennedy’s outstanding efforts to bring about full implementation of the parity law.

The Parity Task Force Report released this week outlines both short-term and longer-term steps to improve compliance with parity requirements. Short-term steps range from $9.3 million in federal CMS grants to states to enforce parity protections, to creation of a consumer portal to help purchasers submit formal complaints of parity violations, to SAMHSA policy academies for the states, to educational materials for state officials and insurance consumers.

Longer-term steps in the report include several that will require Congressional approval, such as more frequent parity audits of insurance plans, financial penalties for parity violations, elimination of opt-out features for self-insurance plans, and elimination of the 190 day lifetime limit on inpatient psychiatric care under Medicare. Other steps seek to strengthen current efforts, such as development of simplified disclosure tools, guidance to address the applicability of parity to opioid disorders, and guidance on disclosure of medical and surgical benefits.

Front end approach

The Kennedy Forum meeting on Wednesday served as the initial effort to organize the field for taking action with the Congress and the incoming administration to move the recommendations set forth by the task force. The forum efforts will continue to emphasize the development of a front end approach to plan compliance through disclosures and audits, rather than simply a back end approach focused on consumer complaints. The Forum also will continue to develop useful tools that can be employed directly by the field.

The Coalition for Whole Health will work closely with the Kennedy Forum to help carry out these next steps. In a future column, I will report on the progress of these efforts.

We salute President Obama for convening the task force, the task force itself for producing a very well-reasoned action report in a very short period of time, and Patrick Kennedy and the Kennedy Forum for serving as the clarion voice of advocacy and the principal locus of private sector efforts to implement important parity protections.

As Patrick Kennedy noted on Wednesday, “The effort to achieve parity really is a civil rights struggle for equity by those with mental health and substance use disorders. Like the original civil rights movement, we all can join our colleagues in this urgent effort.”    


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