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Advocacy Needed as Biden Seeks to Advance Administration's Parity Agenda
More than 15 years ago, former US Rep. Patrick Kennedy ignited the torch in search of financial parity for behavioral health services—the simple concept that behavioral health and medical benefits ought to be the same. He introduced and then led the passage in the Congress of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). For the subsequent intervening years, he sought to implement and expand this legislation so that covered health insurance entities comply with its mandates. Much of this work was conducted by the Kennedy Forum, which the former representative specifically created to bring parity protections to life for millions of Americans.
President Joe Biden now is carrying the parity torch with Kennedy. The president recognizes the essential nature of parity to improve access to mental health and substance use services. Recently, Biden spoke to a White House and national video conference audience to announce new proposed federal parity regulations intended to improve access to these services.
The new proposed regulations will require health plans to make changes when they are providing inadequate access to behavioral health services. These regulations also make it clear what health plans can and cannot do, and they close many existing loopholes. The implementation of these essential regulations throughout the behavioral health field are a key next step in the quest for parity for all Americans.
However, we also must step back and review where we stand in this overall quest.
A few months ago, I prepared the following analysis of parity: Although comprehensive federal statistics are not currently available on the number of Americans with parity protection, it is feasible to offer some approximations. More than 260 million Americans are age 18 and above. Of these, the following groups currently do not have parity protection:
- 54.1 million adults aged 65 and over who are covered by Medicare;
- 40.0 million adults aged 18 to 64 with coverage through traditional Medicaid; and
- 28.3 million adults aged 18-64 who do not have any health insurance coverage at all.
Thus, of the 260 million adults aged 18 and older, approximately 122.4 million (47%) currently do not have parity protection. Further, an unknown number who do have current health insurance either lack parity protection entirely or actually are not receiving the benefits of this protection.
In his FY 2023 federal budget proposal submitted in the spring of 2022, Biden presented a very comprehensive plan to implement and enforce parity across all types of health insurance, both public and private. His proposals included the following elements:
Medicare: The president’s plan would have extended parity protection to the Medicare program. Further, he proposed to expand Medicare mental healthcare coverage and make access more affordable by modernizing fee-for-service mental health benefits, covering 3 behavioral health visits per year without cost-sharing, revising the criteria for psychiatric hospital terminations, and eliminating the 190-day inpatient psychiatric hospitalization lifetime limit.
Medicaid: The president’s plan would have improved Medicaid mental healthcare access. This would be accomplished by increasing access to providers, expanding community behavioral health services, establishing a performance fund to improve behavioral health, and requiring utilization of clinically appropriate criteria for Medicaid-covered behavioral health services.
Private insurance: The president’s proposal included a demand that insurers offer an adequate network of behavioral healthcare providers, 3 visits for each client each year without cost sharing, and a request that Congress enforce parity through the introduction of civil penalties.
Enforcement of parity: The president’s plan would have required federal technical assistance to the states to enforce parity.
Without any doubt, the Biden administration has set forth an essential long-term agenda for parity protections, yet the current Congress did not include these elements in the final FY2023 federal budget. The parity regulations just announced are a key step in this process, directed specifically toward private health insurers and incorporating non-federal governmental health plans, e.g., state, county, and municipal health insurance programs.
When he announced the proposed regulations, the president also announced that the administration has recently issued proposed rules that would expand access to behavioral health care under Medicare by expanding the range of benefits covered; invested $1 billion for enhancing crisis response through 988; and issued proposed rules that would expand Medicaid coverage for behavioral health services in schools.
Now that the Biden administration has taken these unprecedented steps, we need to help move the overall parity agenda. I cannot overstate how critical our advocacy will be to bring all these elements across the finish line. All of us will need to engage in unprecedented advocacy to make this happen. I hope that I have convinced you of the urgency and essence of this task.
Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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