CCIIO should enforce the federal parity law
Recommendation
The Center for Consumer Information and Insurance Oversight (CCIIO) should exercise its authority under 42 U.S.C.. § 300gg-22(a)(2) to enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) in the individual market and for fully-insured, non-federal governmental plans when a “State has failed to substantially enforce” the law. Failure to “substantially enforce” should include solely relying on consumer complaints to determine if there is non-compliance, refusing to investigate all complaints involving mental health and substance use disorder (MH/SUD) denials of coverage for possible MHPAEA violations, and failing to conduct regular market conduct examinations to evaluate insurers’ MHPAEA compliance.[1]
Background/summary
MHPAEA requires equity in coverage between MH/SUD and medical/surgical benefits.[2][3] When passed in 2008, the MHPAEA applied only to group health plans and group health insurance.[2][3] However, in 2010, the Affordable Care Act (ACA) amended the law to include the individual health insurance market.[2][3] State enforcement of parity laws is critical. However, to date, only about 20 percent of states have ever penalized violations.[4] Everyone deserves equal coverage of mental health and addiction treatment services.[5] CCIIO has existing authority to enforce the Parity Law and has a responsibility to step in when a state is failing to do so.[1]
citations
1. The Kennedy Forum. Recommendations of Congressman Patrick J. Kennedy to the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Last Updated October 2017.
2. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. The Mental Health Parity and Addiction Equity Act (MHPAEA). (n.d.)
3. The Kennedy Forum. What is Parity?. (n.d.)
4. The Kennedy Forum. Q&A With David Lloyd: Chief Policy Officer of the Kennedy Forum. Last Updated August 22, 2022.
5. Ibid.