Behavioral health parity

In April 2024, RTI International released a report entitled “Pervasive Disparities in Access to In-Network Care Continue.”

The MH Parity and Addictions Equity Act of 2008 requires that health plans not make it harder to access in-network mental health and substance use disorder benefits than comparable medical/surgical benefits. The RTI report provides data showing that this is not happening.

Here is a link to the full report: https://www.rti.org/publication/behavioral-health-parity-pervasive-disparities-access-network-care-continue

Mark, T. L., & Parish, W. J. (2024). Behavioral health parity – Pervasive disparities in access to in-network care continue. RTI International.

A new report released today from The Bowman Family Foundation confirms the experience that so many NAMI members face – that mental health care is far too hard to find, and for those who do find it, they end up going out of network for much of their treatment.

The report, Equitable Access to Mental Health and Substance Use Care: An Urgent Need, is based on a survey of 2,794 individuals conducted by NORC, including many NAMI members. The survey found challenges for adult-focused services and even more challenges for youth in need of mental health care.

Some key results include:

• 57% of people who sought mental health or substance use (MH/SUD) care were unable to access any care on at least one occasion between January 2019 and April 2022.
• Nearly 70% of adolescents seeking MH/SUD care did not receive any care on at least one occasion during the time period, compared to only 20% for physical health care.
• 39% of people with employer-sponsored health insurance reported using at least one out-of-network provider for MH/SUD outpatient care, compared to just 15% for physical health care.
• Some people found in-patient care, but it wasn’t easy. Two in five individuals who successfully made an appointment with a new in-network MH/SUD provider had to contact four or more providers before securing an appointment.

For the past 20 years, NAMI has fought for parity—the fundamental tenant that mental health care is just as important as physical health care. We have steadily made progress on this issue in both the hearts and minds of the country and its policies.  

NAMI knows that the U.S. system of mental health care is failing to engage many people who seek help. The facts say it all: Many people who seek mental health care drop out. 70% that drop out do so after their first or second visit.

The first moments of interaction between a service provider and a person seeking care for a mental health condition can set the tone and course of treatment. This first interaction can start a journey to recovery and a satisfying life—or it can leave a person unsure or even hopeless about their future and unwilling to go back a second time. 

NAMI recommends that insurance companies take the following steps to improve coverage under federal parity law:

1. Maintain accurate, up-to-date directories of mental health professionals.
2. Provide easy-to-understand information about mental health benefits.
3. Promote integration of health and mental health care; expand these reimbursement models (an example is the Collaborative Care Model).
4. Expand networks of mental health providers (recruit and contract with a wider range of providers, including MH and SA residential and inpatient facilities and allied MH workers such as peer and family support specialists).
5. Cover out-of-network care to fill gaps in providers.

Additionally, they recommend:

1. The State Office of Insurance Regulation (OIR) routinely conduct market audits of all commercial health insurers and Medicaid managed care for compliance with the Federal parity law. Specify measures they are taking to bring them into compliance with parity.
2. Increase reimbursement rates and other incentives for psychiatrists and other mental health clinicians. 
3. Increase reimbursement and reduce barriers for tele-mental health services.
4. Promote use of psychiatric nurse practitioners and other health care professionals with appropriate training to prescribe mental health meds.

Examples of Non-Parity:

• Requiring prior permissions to get MH treatment
• Paying psychiatrists and psychologists less per hour than family and other doctors
• Requiring a med other than what the doctor prescribes because it is less expensive
• Not enough MH practitioners in-network
• Limiting the number of inpatient treatment days when that limitation is not applied to medical benefits

Florida’s OIR (Office of Insurance Regulation) needs the full support of the Florida legislature to evaluate and enforce the Federal Parity Law under the MHPAEA (Mental Health Parity and Addiction Equity Act). Employers who sponsor self-funded health plans that cover Mental Health and Substance Use Disorders should know that any difference between the handling of MH/SUD benefits and comparable medical/surgical benefits is probably illegal.

If parity is enforced:

• Insurance companies will pass the increases in their costs on to the larger pool of consumers, just as they do for other chronic illnesses, such as diabetes or cancer. 
• It will save taxpayers money because they are already paying even higher costs for avoidable ER visits and hospitalization and incarceration than if Mental illness were adequately covered in the first place. 
• The parity law has an “escape hatch” for insurance companies, providing relief to any insurer that, after the first year of full compliance, if the cost of coverage increases more than 2% and, after the second year of coverage, increases more than 1%, the company may seek an exemption from the law.
• For those receiving coverage through Florida Medicaid (800,000 people), it will mean that they get the care they need, early, so that they can lead lives of recovery with brighter outcomes. 

In Florida, the existing law permitting discrimination against MH/SU disorder patients must be repealed, from HB939: 409.967, F.S.; requiring Medicaid managed care plans to submit an annual report to the Agency for Health Care Administration (AHCA) relating to parity between mental health and substance use disorder benefits and medical and surgical benefits; specifying required information in the report; amending s. 627.6675, F.S.; conforming a provision to changes made by the act; transferring, renumbering, and amending s. 627.668, F.S. (commercial health insurance companies).

Since most mental health care is provided through Medicaid and at more reasonable rates, we should expand Medicaid in Florida to include the “working poor” who currently make too much to qualify for Medicaid but also can not afford their own health insurance.

Read NAMI's report, “Mental Health Parity at Risk.”

A report issued by Florida's AHCA (Agency for Health Care Administration), which oversees Florida's Medicaid Managed Care program, found that the average rates of performance for these companies in the behavioral health domain did not meet AHCA’s 2020 performance targets. 

Download and read the report below. Information on performance measures for behavioral health begins on page 22.