Feds Aren’t Proactively Checking for Parity Compliance — But Advocates Say They Should Be

Federal agencies may not be doing enough to ensure behavioral health parity within health plans, according to a recent report from the United States Government Accountability Office (GAO). In response, advocates are calling for more extensive oversight of employer-sponsored group plans.

The report found that the vast majority of federal reviews and investigations into parity compliance come in response to consumer complaints. Few reviews are conducted proactively.

On top of that, federal departments have not evaluated the successfulness of such practices in ensuring parity compliance by employer-sponsored group plans.


Those findings came as a disappointment to the National Association of Behavioral Health (NABH), who says enforcement of parity compliance shouldn’t be an afterthought.

“For years, NABH has heard from our members — who receive complaints from patients and withstand parity violations every day — that the current compliance process is woefully inadequate to determine whether health plans are following the law,” Shawn Coughlin, executive vice president for government relations and public policy at NABH, said in a press release.

NABH is a nonprofit trade organization that represents behavioral health and substance abuse provider systems. It has about 1,800 members who serve patients in a variety of settings, such as in inpatient behavioral healthcare hospitals and units, residential treatment facilities, partial hospitalization and intensive outpatient settings and medication assisted treatment centers, in addition to others.


For the report, GAO officials reviewed policies, guidance and reports from the Departments of Labor (DOL) and Health and Human Services (HHS), the two agencies that oversee parity compliance for group and individual health plans. They also conducted surveys and interviews of state, DOL and HHS officials, among others.

Parity generally requires that insurance coverage for mental health and substance use disorders be no more restrictive than for medical and surgical services. While these requirements were created by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, compliance issues remain widespread more than a decade later.

For example, a recent study found that behavioral health services are far more likely to be out of network and met with lower reimbursement than are physical health services — and those disparities are widening, not improving.

“This is unacceptable,” Coughlin said.

And to some extent, GAO agrees.

It found that in fiscal years 2017 and 2018, DOL completed only 302 reviews of behavioral health parity compliance in its oversight of 2.2 million plans.

“Nearly all these reviews originated from complaints or other information about potential noncompliance with federal health care laws unrelated to mental health/substance use disorder parity,” the report said.

But in the future, that could change.

In the report, GAO recommended that DOL and HHS evaluate their oversight practices, with the goal being to determine whether they’re effective — or whether a different approach needs to be adopted to ensure parity compliance.

DOL and HHS agreed with those recommendations, according to the report.

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