Mental Health Parity at
a Crossroads
With federal agencies
preparing to update parity regulations and Congress considering reforms,
our new brief
explains existing parity requirements, including who they apply to and
how they're enforced, and highlights key policy issues raised by
regulators and advocates that could be addressed in the future.
Those issues include:
- Simplifying
parity standards to make it easier for apples-to-apples comparisons
between behavior health and medical benefits needed to assess
compliance.
- Taking
a closer look at how insurers are using medical necessity criteria
to make behavior health coverage decisions that potentially could
affect people’s ability to access care.
- Developing
enforceable standards to determine the adequacy of provider networks
across the full spectrum of behavioral health needs from screening
to inpatient treatment, including the potential and limits for
telehealth providers to provide coverage.
- Evaluating
enforcement tools to allow regulators to better assess and enforce
parity compliance, potentially including additional data-reporting
requirements or incentives for employers or other plan sponsors to
monitor their behavioral health coverage.
In weighing possible
changes to address such issues, other factors to consider include the
potential increased costs resulting from expanded behavior health
coverage as well as an existing workforce shortage and other structural
problems.
The brief is part of KFF’s
ongoing work examining what consumers and patients face as
they navigate the health care system, including financial barriers,
administrative complexity, lack of transparency, and problems accessing
providers.
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