Issue: Treating mental health conditions and substance use disorders as equivalent to other health conditions in insurance plans (“mental health parity”) continues to be a priority policy concern at the federal and state levels. Measures approved by Congress and state legislatures have established methods for assessing mental health parity on a regular basis. But other issues that have long challenged the nation’s health care system, such as trans-forming payment and delivery of services, may need to be addressed to ensure parity becomes a reality.

Goal: Provide mental health insurance parity policy options for state leaders.

Methods: Review policy challenges, statutes, regulations, and enforcement efforts, and identify future policy avenues.

Key Findings: States continue to address gaps in parity through legislation and through regulatory, enforcement, and compliance efforts. They are requiring 1) insurance companies to demonstrate compliance; 2) insurance departments to report on compliance; 3) coverage of a fuller range of mental illnesses and substance use disorders; and 4) greater transparency by insurance providers. They are attempting to correct the negative outcomes of insurance practices such as prior authorization for services, provider networks, and formulary design.

Conclusion: States have led the way in addressing parity issues with legislation to 1) shape coverage; 2) provide a model for federal legislation; 3) facilitate implementation of federal laws; and 4) ensure insurance market compliance. Bigger challenges lie ahead when it comes not only to ensuring all individuals have access to quality services but also in equipping the overall health care system and other systems to address mental health needs. Numerous factors have generated various successful strategies and solutions with opportunities for expansion in government and practice.

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