n### Progress and Challenges in Mental Health Parity: A Closer Look at the 2024 Report to Congress
The U.S. Departments of Labor, Health and Human Services, and the Treasury have released their 2024 Report to Congress, shedding light on the enforcement and implementation of the Mental Health Parity and Addiction Equity act (MHPAEA). While the report indicates progress in compliance, it also underscores persistent challenges in achieving true parity for mental health and substance use disorder benefits compared to medical and surgical benefits.
A Step Forward,But Not far Enough
The report reveals that group health plans and health insurance issuers are making strides in adhering to the MHPAEA,yet they continue to fall short of the law’s requirements. The departments have been working diligently to strengthen and enforce the protections of MHPAEA, ensuring that participants, beneficiaries, and enrollees face no greater barriers when accessing mental health and substance use disorder benefits. This includes the finalization of new rules for MHPAEA in September 2024, wich aim to bolster these protections further.Acting Secretary of Labor Julie Su emphasized the progress made, stating, “While health plans and insurance companies continue to fall short in providing parity in mental health and substance use disorder benefits, the Department of Labor’s efforts have achieved corrections that have directly benefited over 7.6 million participants in more than 72,000 plans.” She added, “The departments’ recently issued final rules strengthen protections for participants, beneficiaries, and enrollees when trying to access mental health and substance use disorder benefits.”
Enforcement and Awareness Efforts
The Employee Benefits Security Administration (EBSA) and the Centers for Medicare & Medicaid Services (CMS) have ramped up their enforcement activities. EBSA has been using its full authority to ensure that workers and their families do not face greater roadblocks in accessing care for mental health conditions and substance use disorders. Similarly, CMS has increased its enforcement activities in the individual and fully insured group markets in states where it has enforcement authority.
Assistant Secretary for Employee Benefits Security Lisa M. Gomez highlighted the ongoing efforts, saying, “As we continue to strengthen and build on these efforts through regulation, enforcement, and compliance assistance, EBSA is resolute to deliver on the law’s promises.This year’s report highlights not only what plans and issuers need to correct, but also how plans and issuers are making improvements and moving in the right direction.”
Key Enforcement Tools and Annual Reporting
The Consolidated appropriations Act, 2021 (CAA) provided the departments with a crucial new enforcement tool. This tool requires plans and issuers to analyze and document compliance with the law for nonquantitative treatment limitations, ensuring parity between mental health and substance use disorder benefits and medical/surgical benefits. The CAA also mandates annual reporting of these findings. The 2024 report is the third such issuance and fulfills the Department of Labor’s requirement to issue a biennial report to Congress on MHPAEA compliance.
Reducing Stigma and Improving Access
The report also details the departments’ efforts to reduce the stigma surrounding mental health conditions and substance use disorders. It includes an unredacted 2024 settlement agreement between EBSA and a health plan, illustrating the types of actions plans and issuers can take to correct alleged violations of MHPAEA. Additionally, the report provides examples based on enforcement experience, showing how plans and issuers can make corrections to comply with the law.
Enforcement Data and Jurisdiction
accompanying the 2024 Report to Congress is a 2023 MHPAEA enforcement fact sheet, which highlights critically important results from MHPAEA investigations closed by EBSA and CMS in fiscal year 2023. EBSA has primary enforcement jurisdiction over MHPAEA for approximately 2.6 million health plans covering roughly 136 million workers, retirees, and their families. CMS,conversely,has enforcement jurisdiction over MHPAEA for approximately 67 issuers in the individual and fully insured group markets in two states that are not substantially enforcing MHPAEA and for approximately 91,000 non-federal governmental plans nationwide.
Summary of Key Points
| aspect | Details |
|————|————-|
| Progress in Compliance | Health plans and issuers are making progress but still fall short of MHPAEA requirements.|
| New Rules | finalized in September 2024 to strengthen protections for mental health and substance use disorder benefits. |
| Enforcement Efforts | EBSA and CMS have increased enforcement activities to ensure compliance. |
| CAA Enforcement Tool | Requires plans and issuers to analyze and document compliance with MHPAEA. |
| Stigma Reduction | Ongoing efforts to reduce stigma surrounding mental health and substance use disorders. |
| Enforcement Data | 2023 MHPAEA enforcement fact sheet highlights significant results from investigations.|
The 2024 Report to Congress serves as a reminder of the ongoing need to ensure that mental health and substance use disorder benefits are treated on par with medical and surgical benefits. While progress has been made, there is still much work to be done to achieve true parity.
