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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

White House Task Force Releases Parity Recommendations

November 3, 2016 | Parity | Comments
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Last week, the White House Mental Health and Substance Use Disorder Parity Task Force released its recommendations for improving the implementation of the federal parity law. The Task Force report details the Obama Administration’s parity implementation activities undertaken throughout the last eight years, outlines newly available resources, and offers a number of recommendations for future action.

The National Council commends the White House Parity Task Force for its work to advance the cause of parity. “If we are to fulfill parity’s promise, we have a great deal of work ahead of us,” said Linda Rosenberg, National Council President & CEO. “The actions and recommendations released today are an important step in that direction. Now, we must continue working with federal and state regulators to ensure that all consumers can access the care they need.”

Updated resources and guidance released last week include:

  • Answers to FAQs about parity and buprenorphine coverage. Accompanying the report, the Department of Health and Human Services has issued sub-regulatory guidance in the form of a new set of FAQs related to parity in commercial plans under the Affordable Care Act. Pages 11-14 provide clarity on how parity applies to coverage for buprenorphine; the guidance includes specific examples of how common utilization restrictions such as prior authorizations and fail-first policies fall afoul of the parity law.
  • Creating a one-stop parity web portal to help consumers navigate parity. The portal, launched today in beta mode, links consumers directly to information about how to file an appeal or complaint. The Task Force report noted that today’s release is a “starting point” for future efforts to increase the site’s functionality.
  • Expanding consumer education about parity protections. The Department of Health and Human Services today released a “Consumer Guide to Disclosure Rights” offering clear information about the types of information plans are obligated to disclose to consumers as they are selecting plans or evaluating whether their plan has unfairly denied a mental health or addiction service. The guide encompasses a number of scenario-based potential parity violations and explains what documentation consumers are entitled to request.

Among the Task Force’s recommendations for future action are:

  • A review of how parity principles apply in Medicare. The report acknowledges that we have a long way to go in establishing parity in Medicare; the Administration commits to identifying needed improvements in Medicare to advance parity and continuing to advocate with Congress for a repeal of the 190-day lifetime limit on inpatient psychiatric treatment.
  • Increasing federal support for state efforts to enforce parity. Among planned activities are $9.3 million in grant awards to states to support parity implementation; and two State Parity Policy Academies designed to help state officials advance strategies for parity compliance drawing on lessons learned from other states.
  • Developing additional examples of how non-quantitative treatment limitations are regulated by the parity law. The Task Force notes that it will release an updated version of its “Warning Signs” document identifying potentially problematic cases of NQTLs.
  • Increasing federal agencies’ capacity to audit health plans for parity violations. Parity enforcement efforts to date have focused principally on addressing complaints filed after service denials occurred. The example of the state essential health benefits benchmark plans—which often failed to include services at parity as required by the law—shows that additional front-end compliance tools are needed.

The National Council looks forward to seeing future guidance identifying problematic use of non-quantitative treatment limitations, and we encourage the Administration to update its medication-assisted treatment guidance to clarify that the cases identified in the FAQs apply to the full range of FDA-approved medications, not just buprenorphine.

The National Council provided further comment on the Task Force report in the form of a joint letter signed by numerous national behavioral health advocacy organizations. The letter recommends clarifying adequate disclose requirements, requiring prospective parity compliance reviews, streamlining the consumer complaint process, and providing guidance for identifying plan standards that violate the parity law.

For continued updates on parity implementation, stay tuned to future emails from the National Council.