As our country faces a devastating and escalating addiction epidemic, the Legal Action Center, in partnership with The National Center on Addiction and Substance Abuse, Partnership for Drug-Free Kids, and the Treatment Research Institute (TRI), has developed the Addiction Solutions Campaign (ASC). The ASC represents a coordinated effort to leverage the organizations’ collective expertise across research, policy and communications to tackle broad-impact projects. One of the ASC’s first major initiatives is to increase consumer access to addiction coverage and services that they are entitled to under the Mental Health Parity and Addiction Equity Act of 2008.
While the Parity Act requires substance use disorder and mental health benefits in both the public and private health insurance markets be comparable to, and no more restrictive than, the standards for other medical/surgical benefits, enforcement of the law often falls incredibly short. The ASC recently completed an in-depth analysis of publicly available documents for seven major health plans offered in 2015 and 2016 in the small and large group markets in New York and Maryland. The findings raise serious questions about whether the current enforcement framework is adequate to protect consumer rights as detailed under the Parity Act. In a recent article in Behavioral Healthcare Executive Paul Samuels, President/Director of the Legal Action Center, says “Anecdotally for many years, it has been apparent that it’s very difficult for consumers and regulators to find out what’s actually covered in plans for substance use disorders and mental health, and whether that complies with the Parity Act… What we were able to do in this study is to confirm through rigorous analysis that those problems are real.”
As the American Medical Association noted in a recent statement about the ASC Parity Report, “Increasing access to treatment is an essential component of reversing the nation’s opioid epidemic. We hope this report spurs insurers and regulators to act.”
A flaw in the current enforcement framework is that it primarily relies on consumers to raise issues with parity compliance, and our analysis found that consumers are not provided with sufficient information by insurance plans to determine what treatment benefits they are eligible for and what barriers exist to accessing those benefits. Furthermore, the analysis found that state insurance regulators likewise do not have sufficient information from insurance companies to confirm that their policies comply with the Parity Act.
The ASC has developed specific recommendations to shift the current enforcement framework from one focused on consumer complaints to prospective regulatory review, which would require regulators obtain a Parity Transparency and Compliance Report from insurers documenting that they are responsive to Parity Act standards prior to plan approval. “Critical details about coverage and access to treatment are often missing from plan documents. It would be challenging – if not impossible – for an average consumer to know whether a plan violates the Parity Act,” says Ellen Weber, Vice President for Health Initiatives at the Legal Action Center and lead author of the report. “Yet, the current system relies on consumers to report problems to insurance regulators. When regulators don’t receive complaints, they assume the plans are in compliance. Our analysis reveals that most parity violations cannot be identified through consumer complaints nor can they be identified via form review. We need to shift our approach so that plans are demonstrating compliance BEFORE they are marketed to consumers. Regulators can and should demand this information.”
In order to document the challenges that consumers have in accessing addiction treatment coverage and to boost our call for systemic change in the enforcement framework, ASC has created the following petition for consumers to sign on to.