Five years after mental health parity law, problems still linger

Five years after a law intended to guarantee parity for those seeking mental healthcare took effect, access to services and a lack of enforcement remain as problems, according to a new policy brief from Health Affairs and the Robert Wood Johnson Foundation.

Many insured Americans are still struggling when it comes to access to equal benefits and finding qualified mental health providers, despite the passage of the Mental Health Parity and Addiction Equity Act, the brief says. The law was passed by Congress in 2008 and requires insurance providers that include treatment for mental health or substance use as a benefit in insurance plans to provide those services under the same terms as other medical conditions.

"While there have been some improvements since the law passed, access to timely, in-network mental health and substance use providers remains a problem," according to the policy brief.

As FierceHealthPayer previously reported, some health insurers are finding ways around the parity law, limiting treatment through strategies that are difficult to track such as a "medical necessity" review to determine whether a patient requires a certain treatment.

With a few exceptions, enforcement of the law has also been minimal, the brief says. Enforcement is handled by a "patchwork"of regulatory authorities; states work with consumer complaints in some cases, and in others, the federal Department of Health and Human Services manages them, the brief says.

With little state and federal enforcement, patients--sometimes joining with mental health advocacy groups--have filed lawsuits against health plans for denying benefits, the brief says. Lawsuits seeking class-action status are pending in California, Illinois and New York, according to the brief.

In addition, a new report has found that plans offered on insurance marketplaces have a significant level of variability in their coverage of antidepressant medications. The report, from researchers at the Urban Institute with funding from the Robert Wood Johnson Foundation, said that consumers shopping for an insurance plan may have difficulty determining which antidepressants are covered by a specific plan and how much they will have to pay out-of-pocket for the drugs.

To learn more:
- read the policy brief
- find the report on antidepressants