Even though federal oversight has remained at relatively consistent levels since the enactment of the Mental Health Parity and Addiction Equity Act (MHPAEA) over ten years ago, many states are showing signs of increased vigilance when it comes to promoting and protecting the precepts behind the Act, leading experts told attendees of a webinar, “URAC’s Parity Program: What You Need to Know,” March 31 and sponsored by URAC.
“While there have been substantive regulations and guidance issued, states and the federal government are still trying to grapple with enforcing the law,” said Brittany McCullough, Health Policy Specialist at URAC. “Additionally, health plans are trying to better understand how to best comply with the new obligations that parity has introduced.”
Enacted in 2008, the MHPAEA does not mandate behavioral health coverage, but does require it to be comparable to other insurance coverage if it is offered. The goal behind MHPAEA is to minimize discriminatory practices and increase access to behavioral care.
A wide swath of health plans must comply MHPAEA. Those under its jurisdiction include:
- Employer-sponsored plans with 51+ employees
- ERISA-governed TPAs
- The majority of individual and small group health plans
- The Federal Employees Health Benefits plan (FEHB)
- Most state or local government plans
- Medicaid managed care
Several states have recently ramped up their enforcement of MHPAEA – either directly or by more indirect means, said Kevin J. Malone, Senior Counsel, Epstein Becker Green. “There has definitely been an increase in regulatory risk” when it comes to non-compliance at the state level, he said.
Specifically, Massachusetts has been “extremely aggressive” in its enforcement of MHPAEA, Malone noted. In addition, New York and Washington have recently signaled tougher enforcement around data collection and market conduct exams, while Pennsylvania and New Hampshire, among other states, appear to be moving in that direction as well.
On the legislative front, Illinois and Colorado are among states raising the regulatory bar in terms of requirements regulated entities must meet in order to remain in compliance, Malone said.
On the federal level, the Department of Labor has opened nearly 4,000 MHPAEA enforcement investigations since 2011. In fiscal year 2019, Malone said, the Labor Department investigated 186 health plans for potential violations, including both fully insured and self-insured plans.
Perhaps not surprisingly, employers are increasingly interested in compliance programs and actively managing their litigation risk, Malone said.
Unfortunately, compliance is not easy, McCullough and Malone agreed. There are a number of factors making it a challenge, including the complexity and inconsistency of some of the requirements in the laws themselves. “The regulations are complex and expansive,” Malone said. Further complicating matters, there are many different approaches to enforcement and inconsistent standards.
To help meet these demands, URAC recently unveiled its Mental Health and Substance Use Disorder (MH/SUD) Parity Program. It is comprised of three components: The Compliance Guide, the Parity Manager, and the MH/SUD Parity Accreditation. Attaining the accreditation “shows how important parity compliance is to your organization,” Malone said.
The full webinar is available on demand at no charge.
Learn more about URAC’s MH/SUD Parity Program.