We Have Mental Health Parity Laws! Is Our Work Done? Implementing and Enforcing Mental Health Parity at the State Level

Picture of Kelly O’Brien

Kelly O’Brien, The Kennedy Forum Illinois

When the historic Mental Health Parity and Addiction Equity Act of 2008 (“Federal Parity Law”) was enacted, Americans expected to have fewer barriers to access mental health and addiction services, and expected that behavioral health benefits would be provided on par with other medical/surgical health plan benefits. As Tim Clements of ParityTrack shared in a previous CFYM post, it is largely the state regulatory agencies that are responsible for implementing and enforcing the Federal Parity Law. Unfortunately, it’s now eight years since MHPAEA became law, and most states have not fulfilled that obligation, including Illinois. The result is that health plan beneficiaries continue to be denied access to behavioral health services and remain unaware of their right to access care as a part of their health plan’s covered benefits.

Authored by former Congressman Patrick J. Kennedy, founder of The Kennedy Forum, the law requires health insurance plans to guarantee that financial requirements and limitations on treatment benefits for mental health or substance use disorders are no more restrictive than the insurer’s requirements and restrictions for medical and surgical needs. The Affordable Care Act (sometimes known as Obamacare) expanded the Federal Parity Law to apply to even more health insurance plans.

How Illinois is taking action
To address lack of regulation and to expand parity to health plans beyond what the federal law requires, states like Illinois have adopted new laws that codify and improve enforcement. Heroes like Illinois State Rep. Lou Lang have advanced improvements in parity at the state level. Most recently, Illinois adopted HB0001 (Public Act 099-0480). Championed as a response to the heroin epidemic, the bill included language to strengthen the federal and state parity efforts. Both chambers of the Illinois General Assembly passed the bill, but Governor Bruce Rauner vetoed it. Fortunately, with strong bipartisan support, the General Assembly overrode the Governor’s veto. Now Illinois not only has some of the most progressive laws to address opioid and heroin addiction, but also one of the most comprehensive parity laws in the nation. In fact, Illinois’ law serves as much of the basis for ParityTrack’s model state legislation.

Yet, in many ways, the work has just begun. Our Public Opinion Study revealed that 62% of Illinoisans believe physical health is treated with “more importance” than mental health in the current healthcare system. Further, the study pointed out that confusion exists over whether or not the current law provides equal coverage for mental health benefits.

Because we are concerned that a strong law to protect plan beneficiaries is not yet actually protecting them, The Kennedy Forum Illinois convened stakeholders in January 2016 to provide technical assistance to—and in some cases pressure on—state regulators to fully implement the law. The Illinois Parity Implementation Coalition (IL PIC) includes nearly 30 consumer organizations, providers, academics, legal experts, and others working together to help make improved access and insurance coverage for behavioral health care a reality. We meet monthly, sharing information, aligning strategy and messaging, and, in some cases, divvying up the work.

Working with state agencies
Together we’ve learned that the one of the biggest challenges in Illinois isn’t passing mental health parity legislation: it’s ensuring implementation of and compliance with the existing law. The Coalition has taken several steps to correct these shortcomings. One step was to reach out to a key mental parity regulatory body—the Illinois Department of Insurance (IDOI)—on ways that we can work together to better educate consumers and providers about the protections provided under law, develop simpler processes for reporting possible violations of the law, and improve oversight of insurance companies who might be incorrectly denying mental health and addiction services.

Another important step was to outline the parity provisions of IL law, implementation deadlines, and respective state agencies responsible for implementation of each provision. Using this as a guide, the IL PIC is tracking implementation and assisting regulators by providing relevant examples of best practices in other states. We have identified a number of priority focus areas, including the law’s requirement for a Consumer Education Campaign and a new Consumer Hotline. We have also identified a number of gaps and areas where we believe our state could improve its oversight, such as requiring plans to report information necessary to determine compliance and undertake a concerted examination of network adequacy failings.

Sometimes it is difficult to know if agency regulators are resistant to proactive oversight and enforcement or if they are simply challenged with lack of capacity and internal expertise. For this reason, we are encouraged that Illinois (through the IDOI) was among the states that applied for funds from the Centers for Medicare & Medicaid Services (CMS) to support capacity to implement parity. We urged the State to do this and assisted them with drafting the application.

Producing results
Often, we assume that once there is a law, everything will fall into place. We anticipate that the insurance industry and regulatory agencies will promptly update all of their procedures to make sure the spirit and the letter of the law is adopted. But it’s not that simple. Much work still needs to be done and The Kennedy Forum and the IL PIC are picking up steam. We plan to

  • Field a provider survey to collect claims data and trends related to the types of denials providers are experiencing and other barriers to care that may indicate parity violations. In partnership with the Illinois Health and Hospital Association, the Illinois Association for Behavioral Health, and the Illinois Psychiatric Society, we will collect and report information from hospitals, community based providers, and psychiatrists.
  • Finalize a guide for regulators and plans that can assist with testing compliance and developing market conduct surveys or exams. (This is being developed at the national level with key partners including the National Parity Implementation Coalition and the American Psychiatric Association.)
  • Develop a robust consumer and provider education campaign to inform plan beneficiaries of their rights and provide better tools to help families and providers navigate the system and appeal a denial if necessary.
  • Work more directly with health plans, better understanding their concerns and barriers to fully implementing parity.

The work continues
Throughout this process, the importance of keeping the community mobilized and coordinated—even after a bill becomes law—has become critical. The Kennedy Forum and the IL PIC will continue to advocate for full implementation of both the Federal Parity Law and the state law on behalf of plan beneficiaries who use mental health services. We believe that all families have a right to needed behavioral health and addiction services and treatments, subject to the same terms and conditions as care and treatment for any other condition, without regard to diagnosis, severity, or cause. Patients should receive care based on the best medical evidence. The law requires this, and we will continue to work to ensure that the people of Illinois are receiving the mental health and addiction treatment services they are entitled to under the law.

Your Turn

  • Have you or a family member been incorrectly denied access to mental health care?
  • How are you evaluating your plan to understand if you have been incorrectly denied care?

Kelly O’Brien is Executive Director of The Kennedy Forum in Illinois. Just as President Kennedy rallied the nation to dream big and set audacious goals 50 years ago, The Kennedy Forum seeks to set a new standard for the future of health care in the United States. Kelly has served in public health policy leadership positions in the public and private sector, with Senator Richard Durbin (D-IL), Congressman Jerry Kleczka (D-WI), The Centers for Disease Control Prevention (CDC); the American Public Health Association, Girls on the Run, and United Way of Metro Chicago. She currently serves on the Board of Chicago Cares, volunteers as a Sea Scout Adult Leader, and is generally overcommitted on multiple other volunteer responsibilities. She balances work with endurance sports, sailing, travel and reading.

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