Spotlight on Mental Health and Substance Use Disorder Parity Compliance Standards

Background

In order to enforce the Mental Health Parity and Addiction Equity Act, regulators must have information that explains health plan features that may limit care.

This information is typically not available to regulators because it is in the sole possession of health plans opposed to disclosure. Traditional regulatory enforcement activities — such as form review, post-market investigations and market conduct examinations, and consumer complaints — have proven inadequate to capture this information or prevent the sale of sub-standard plans.

Key findings

• As of July 2020, 15 states and the District of Columbia have enacted laws requiring health plans to submit compliance reports and/or quantitative data on the development and application of non-quantitative treatment limitations (NQTLs) and quantitative data that identifies disparities in plans’ operations.
• As of July 2020, 16 states and the District of Columbia have enacted legislation requiring State Insurance Departments to report on their enforcement activities to their state legislatures.
• At least 30 states include some level of Parity Act compliance review as part of the insurers’ form submissions.

Recommendations

States should adopt laws requiring health plans to submit compliance reports and quantitative data on an annual basis and ensure that parity violations are resolved prior to sale of the plans. In addition, states should require their Insurance Departments to report annually on parity enforcement activities.