Recent State Legislative Activity to Ensure Mental Health Parity

May 16, 2019|11:10 a.m.| ASTHO Staff

May is Mental Health Month, a time to recognize the ways mental health is tied to state health agency priorities, such as chronic disease, substance misuse, and suicide prevention. According to the National Institute of Mental Health, there is a strong link between mental illness and chronic disease with, for example, depression increasing the risk of cardiovascular disease, diabetes, stroke, and Alzheimer’s disease. To include mental health as part of a continuum of care with behavioral health, prevention, and physical care, policymakers at the federal and state levels have sought to increase the parity between the accessibility of mental health services and other care.

Parity requires insurance providers to cover mental health services at an equitable rate to physical care coverage. Congress took the first step towards equitable access with the 1996 Mental Health Parity Act, which required comparable annual and lifetime dollar limits on mental health benefits and physical health benefits. In 2008, Congress moved further with the Mental Health Parity and Addiction Equity Act (MHPAEA) and mandated that insurance companies offering mental health and substance use benefits provide coverage that is comparable to physical services in treatment limits, cost sharing, and in- and out-of-network coverage. Although MHPAEA does not require all insurance providers to cover mental health services, the legislation improved access by requiring equal standards of coverage. In October 2016, the Mental Health and Substance Use Disorder Parity Task Force released a report outlining federal progress in enforcing the statutes and made recommendations for ensuring comprehensive coverage.

Despite efforts at the federal level, in a 2016 National Alliance of Mental Illness report 28 percent of respondents stated that they used an out-of-network mental health therapist while only three percent used an out-of-network primary care provider. Respondents also reported higher out-of-pocket costs and barriers to securing mental health providers—for example, providers who were not accepting new patients or the patient’s insurance plan.

A comprehensive analysis of state mental health parity laws indicates there is room for improvement in the implementation and enforcement of the laws. Recent state legislative trends to increase access to mental health services include bills to establish mental health parity, to report the compliance with state and federal mental health parity laws, the formation of workgroups, and the enforcement of mental health parity requirements. Below is an overview of state legislative activity around the establishment of mental health parity requirements and compliance with both federal and state law.

In Wyoming and New Jersey, bills were recently enacted for health insurance policies to meet the requirements of the MHPAEA. In Colorado, the legislature has sent a bill to the governor that requires mandatory insurance coverage for behavioral, mental health, and substance use disorders, including the prevention of, screening for, and treatment of those disorders, and compliance with MHPAEA. The Illinois senate passed a bill directing insurance providers to ensure parity for the payment for any diagnosed “mental, emotional, nervous, or substance use disorder or condition.” The proposed bill is currently in the house.

In New Hampshire, a bill was introduced to include mental health expenses in the spend down requirements for state medical assistance. The Connecticut legislature also considered bills related to mental health parity and expanding mental health care options. One bill, SB333, would require certain health insurance policies cover screenings for mental or nervous conditions during covered annual physicals and require that health carriers comply with MHPAEA. Another bill, HB5897, would establish reporting requirements for insurers to demonstrate the parity between mental health and physical health services. Legislators in Minnesota also introduced multiple bills establishing mental health parity. Two sets of companion bills (SF1229 and HF1340 as well as SF379 and HF254) would prohibit health plans from imposing certain treatment limitations for mental health and substance use disorders. SF1129 and HF1340 would also give the commissioner of health authority to require information from health plans to confirm that mental health parity is being implemented.

To help achieve parity, the Substance Abuse and Mental Health Services Administration (SAMHSA) compiled a set of best practices that states can use for enforcing and monitoring compliance with parity laws. Collaboration between federal and state agencies, consumers, stakeholder and advocacy groups, and insurance providers to improve parity compliance is among SAMHSA’s recommendations. State and territorial health officials are well-positioned for such collaboration and can play key roles in expanding access to mental health services by educating the public and policymakers about the benefits of parity and the inclusion of parity in state-sponsored insurance coverage. As more states seek to address the mental health parity, ASTHO will continue to monitor and inform its members about this important public health issue.

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