White House Task Force Issues Report to Improve Parity Compliance

The Obama Administration wants to improve health plan compliance with the federal mental health parity law, strengthen the government’s ability to monitor and enforce compliance, and assist individuals in seeking redress of complaints regarding health plans’ compliance with the law.

Last month the White House Mental Health and Substance Use Disorder Parity Task Force issued its “Final Report to the President” in which it outlined recommendations to better enable states and the federal government to monitor compliance by health plans with the Mental Health Parity and Addictions Equity Act and to assist individuals in finding help with parity complaints and appeals.

“Parity is only meaningful if health plans are implementing it well, consumers and providers understand how it works, and the government provides clear guidance and appropriate oversight,” stated Task Force Chair Cecilia Munoz in a summary accompanying the report. She is an assistant to President Obama and director of the Domestic Policy Council.

The task force developed its recommendations through a series of “listening sessions” with stakeholders held between March and October. APA provided input through written comments, and members were invited to offer their comments at a session held in May at APA’s 2016 Annual Meeting in Atlanta.

“APA welcomes this much-needed report to strengthen implementation and enforcement of the mental health parity law,” said APA President Maria A. Oquendo, M.D., Ph.D. “Full implementation and stronger enforcement will help ensure that psychiatric conditions are treated the same as other illnesses and individuals can access the treatment they need.”

In conjunction with the final report, the task force announced an additional series of immediate action steps to advance parity. Here are some of these steps:

• To help support states’ role in parity implementation, CMS announced in conjunction with release of the report that it will be making grants totaling $9.3 million to help states implement parity protections. Stakeholders told the task force that states need support and resources to ensure issuer compliance with parity.

• The task force introduced a beta version of the Mental Health and Addiction Insurance Help Consumer Portal to help consumers find the appropriate federal or state agency to assist with their parity complaints, appeals, and other actions. The task force received many comments about the challenges consumers face in identifying the appropriate agency that regulates their insurance coverage.

• In conjunction with release of the task force report, the Department of Labor and the Substance Abuse and Mental Health Services Administration published the “Consumer Guide to Disclosure Rights” to help consumers and providers understand what type of information to ask for when inquiring about a plan’s compliance with parity. The guide includes 11 scenarios, each with specific suggestions for information to which consumers have a right to know, as well as timing requirements for plans and issuers providing these documents.

• The departments of Health and Human Services, Labor, and Treasury are issuing subregulatory guidance in the form of frequently asked questions on parity and opioid use disorder addressing specific questions on opioid treatment access, coverage of court-ordered treatment, and how to seek help from the federal government with mental health and substance use disorder benefits.

These are some of the longer-term recommendations included in the task force’s final report:

• The administration should extend the capacity of federal agencies to audit health plans for parity compliance. Stakeholders have consistently called for enhancing audit capacity to improve oversight and enforcement of parity protections. The task force concurred with this view and recommends increasing resources for this purpose.

• Congress should authorize the Department of Labor to assess civil monetary penalties for parity violations. Commenters called for stronger enforcement tools, and the task force recommends providing the Department of Labor with this increased authority.

• The federal government should work with the National Association of Insurance Commissioners and states to develop a standardized template that states could use to help assess parity compliance. Commenters noted the challenge of state variation in approaches to parity oversight.

• The administration should ensure timely implementation of new Medicaid and TRICARE parity rules.

“Adoption of the task force recommendations is essential to achievement of parity for patients with mental illness,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “APA trusts that Congress and the Obama Administration will work together to ensure that the recommendations become reality. APA stands ready to work with Congress and the White House in monitoring implementation. We will also work with our members to insure parity.”

As part of wider administration efforts to expand access to treatment for people with mental health and substance use disorders, President Obama signed a Presidential Memorandum in March creating the Mental Health and Substance Use Disorder Parity Task Force. The goal is “to better ensure compliance with and implementation of requirements related to mental health and substance use disorder parity, and determine areas that would benefit from further guidance.”

Task force membership includes the heads of the following agencies and offices or their designees: the White House Domestic Policy Council, the Department of the Treasury, the Department of Defense, the Department of Justice, the Department of Labor, the Department of Health and Human Services, the Department of Veterans Affairs, the Office of Personnel Management, and the Office of National Drug Control Policy.

Objectives of the task force are to increase awareness of the protections provided by the parity law; improve understanding of the requirements of parity among key audiences including health plans, insurers, and state regulators; and increase transparency around compliance with parity and the support, resources, and tools available to ensure coverage is in compliance with mental health and substance use disorder parity. ■