While some state officials have had more success than others, most states struggle to enforce mental health parity requirements set by federal law, according to a new report from the Georgetown University Center for Health Insurance Reforms (CHIR) and the Robert Wood Johnson Foundation (RWJF). One of the report’s authors and a mental health patient advocate both say that states need more resources to enforce parity requirements.
State officials have the responsibility of enforcing federal statutes such as the Mental Health Parity and Addiction Equity Act (MHPAEA) in the individual and fully funded employer health plan markets. Many states also have their own parity statutes as well. However, as the report puts it, “federal and state regulators have found that enforcing the complex law is challenging. While insurers’ quantitative barriers to treatment such as cost-sharing or visit limits can be relatively straightforward for regulators to assess, certain ‘non-quantitative’ treatment limits [NQTLs], such as the use of prior authorization, provider reimbursement, and formulary design are much more difficult.”