The U.S. Government Accountability Office (GAO) recently issued a report titled “MENTAL HEALTH AND SUBSTANCE USE: State and Federal Oversight of Compliance with Parity Requirements Varies.” The document paints a dismal picture of current efforts to hold health insurers accountable under the Mental Health Parity and Addiction Equity Act (Federal Parity Law), which requires them to cover treatment of mental health and substance use disorders no more restrictively than treatment for illnesses of the body, such as diabetes and cancer. As suicides and overdoses continue to push down U.S. life expectancy, oversight of parity compliance is more important than ever before. That’s because most families depend on their health insurance to pay for costly treatment. When unlawful insurance practices go unchecked, people are left to fend for themselves—often having to limit or forgo care altogether.

Key findings of the report include:

• In 2017-18, only 12 states performed targeted parity reviews to monitor compliance.
• Only 20 out of 50 states reported that they had ever done targeted reviews focused on specific issuers or parity compliance concerns.
• 12 states said they did not even track mental health and substance use disorder parity complaints.
• Of the 18 states that reported conducting routine market conduct examinations (ranging from every 3-5 years), only 9 states reported that they usually or always include a review of parity compliance. 
• The U.S. Department of Labor (DOL), which oversees parity compliance on a federal level, has less than one investigator for every 12,500 employee benefit plans the agency oversees.

Read the full report here. 

The GAO made two recommendations based on its report: one to DOL’s Employee Benefits Security Administration and one to the U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS). 

• Recommendation 1: “The Assistant Secretary of Labor for the Employee Benefits Security Administration should evaluate whether targeted oversight in response to information received is effective for ensuring compliance with MH/SU parity requirements. If this evaluation determines the current targeted oversight approach results in significant program risks, the Employee Benefits Security Administration should develop a plan to more effectively enforce MH/SU parity requirements and, if necessary, seek additional oversight authority, as warranted.” 

• Recommendation 2: “The Administrator of CMS should evaluate whether targeted oversight in response to information received is effective for ensuring compliance with MH/SU parity requirements for non-federal governmental plans. If this evaluation determines the current targeted oversight approach results in significant program risks, CMS should develop a plan to more effectively enforce MH/SU parity requirements and, if necessary, seek additional oversight authority, as warranted.” 

The Kennedy Forum strongly encourages DOL, HHS, and CMS to implement the recommendations put forth by GAO. We plan to use data from the report in our advocacy efforts across the nation. Clear, consistent oversight of parity compliance is critical to expanding access to care for those with mental health and addiction challenges. Learn more about parity at www.DontDenyMe.org.