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State and federal regulators have no way to know how well health insurers, or self-insured employer health plans, are complying with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

Officials at the U.S. Government Accountability Office (GAO) look at the state of MHPAEA compliance in a report released last week.

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Analysts at Milliman — an actuarial consulting firm that typically works for insurers — recently reported that there are obvious signs that health plans are providing much weaker coverage for mental health care and substance use disorder care than for other types of health care.

One sign of the weakness is that patients are much more likely to get behavioral health care out of network, and the gap between use of out-of-network providers for medical care and behavioral care widened between 2013 and 2017, according to Milliman.

GAO officials say in their new report that the Employee Benefits Security Administration (EBSA), the Centers for Medicare and Medicaid Services, and state insurance and health plan regulators have little comprehensive MHPAEA compliance data.

California regulators received 523 parity-related complaints in 2017 and 2018, and that large number of complaints was due mainly to complaints filed by behavioral health care facilities and providers, GAO officials say in their report.

The other 50 states and the District of Columbia reporting getting an average of only about nine MHPAEA complaints each over the two-year period.

MHPAEA compliance reviews were much less common than complaints: All states combined reported organizing just 70 targeted MHPAEA reviews in 2017 and 2018.

During the same period, the Centers for Medicare and Medicaid Services closed five MHPAEA-related reviews in 2017 and 2018.

The Employee Benefits Security administration received 255 MHPAEA-related complaints and opened 21 MHPAEA compliance reviews.

One of the EBSA investigations involved a company that provides or administers behavioral health coverage for about 7 million people. EBSA discovered that the issuer was requiring preauthorization requests for all behavioral health services, even though the issuer was not requiring preauthorization for medical surgical and medical benefits. EBSA made the issuer eliminate the blanket preauthorization requirement for behavioral health services.

Some agencies, including EBSA, told the GAO that they lack the resources to do much about enforcing MHPAEA compliance, GAO officials report.

The GAO is recommending that agencies should look into going go beyond responding to complaints and conducting broader compliance reviews.

Resources

A link to the GAO’s new MHPAEA compliance report is available here.

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