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Wednesday, March 2, 2022

Enforcement of Mental Health Parity Law

The Politics of Autism includes an extensive discussion of insurance and  Medicaid services for adults with intellectual and developmental disabilities.

In his State of the Union last night, President Biden said: "And let’s get all Americans the mental health services they need. More people they can turn to for help, and full parity between physical and mental health care. "

Katie O'Connor at Psychiatric News:
Federal agencies are using recently gained authority to crack down on health plans that are not complying with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. A recent report to Congress outlines the enforcement work that has been done so far and illustrates the extent to which many plans are out of compliance, potentially cutting off thousands of people from the mental and substance use disorder treatments they need.

The report was issued by the departments of Labor (DOL), Health and Human Services (HHS), and Treasury as a requirement of the Consolidated Appropriations Act (CAA), which was enacted in December 2020 and included APA’s priority legislation, the Strengthening Behavioral Health Parity Act. The CAA amended MHPAEA to require health plans to perform and document comparative analyses of their non-quantitative treatment limits (NQTLs), which are the elements of a health plan’s coverage that are not numerical, such as prior authorization and formulary design.

NQTLs have, historically, been difficult to identify, and it is challenging for federal and state agencies to determine whether plans’ NQTLs comply with the parity law (Psychiatric News). The comparative analyses are vital for parity enforcement: Before the CAA, plans were not explicitly required to demonstrate and document that their NQTLs complied with the parity law, which was a major roadblock for enforcement.


The report includes several examples of enforcement leading to expanded access. EBSA discovered that a large service provider of self-funded plans was excluding applied behavior analysis (ABA) treatment for children with autism spectrum disorder. ABA “can improve the trajectory of a child’s development,” the report noted. After issuing requests for comparative analyses and initial findings of noncompliance to some of those plans, three health plans confirmed that they will now cover ABA therapy for autism, impacting over 18,000 plan participants. [See page 21 of the report.]