What is Parity?
Currently, Connecticut legislation requires that insurance providers follow the regulations set forth in the federal Mental Health Parity and Addiction Equity Act (MHPAEA) that was enacted in 2008. However, it was not always clear if these regulations were understood or activated in private health insurance plans.
The Milliman report (updated in 2019 with data through 2017), “Addiction and Mental Health vs Physical Health: Widening Disparities in Network Use and Provider Reimbursement Rates,” showed that the disparity gap continues to expand. The report identified CT as the state with the highest disparity between physical and behavioral healthcare in terms of the proportion of office visits that are out-of-network. Significant disparities were also identified in inpatient care and payments to behavioral health providers compared with primary care providers.
The CT Parity Coalition, and many advocates who came before this group formed in 2018, came together with legislators with the purpose of ensuring private health plans follow the law. In 2019, 30+ states adopted new legislation to standardize compliance with the federal law. Across the country, compliance is generally accepted as:
- Establish reporting requirements for insurers to demonstrate how they design and apply their managed care tactics, so regulators can determine if there is compliance with the law
- Specify how state insurance departments can implement parity and then report on their activities
Passing this legislation is an important step towards ensuring that consumer rights are protected.
Parity Wins in 2019
In July 2019, Governor Ned Lamont signed “An Act Concerning Mental Health and Substance Use Disorder Benefits (Public Act No. 19-159) [link to: https://www.cga.ct.gov/2019/ACT/pa/pdf/2019PA-00159-R00HB-07125-PA.pdf), a law that received unanimous, bi-partisan support and requires that private insurance plans follow the regulations set forth in the 2008 federal Mental Health Parity and Addiction Equity Act (MHPAEA). The Federal law states that health care coverage for mental health and substance use disorders can be no less restrictive than for medical and surgical benefits.
Beginning in 2021, data will be collected on insurance plans (thanks to the 2019 law) to see where the gaps in plan design and coverage exist.
In 2019 (and updated in 2020), the actuarial firm Milliman released a groundbreaking nationwide study showing evidence that consumers across the country are finding it increasingly difficult to access affordable behavioral healthcare (mental health and substance use disorder treatment) under their private health insurance plans. The report sheds light on this disturbing trend over a five-year period beginning in 2013, which documented widening disparities in access to in-network services for mental health and substance use disorder treatment among 37 million employees and their families.
Sadly, Connecticut is ranked among the worst. Findings include:
- Connecticut outpatient access is the worst – ranking #1 – as the state most likely to see behavioral health office visits land out-of-network at 11.5 times the rate as for primary care office visits
- Reimbursement rates for Connecticut behavioral health providers were nearly 42% less than for other doctors
- Connecticut’s out-of-network inpatient use has nearly tripled in 4 years
- Out-of-network outpatient facility use in Connecticut is nearly two times the national average
“While I’m sickened and saddened to once again see Connecticut rank dead last when it comes to in-network coverage for mental health and substance use disorder, the recent findings by Milliman underscore why it was so important that we finally passed mental health party reform this year so that starting next year insurance companies will finally be held accountable for treating the behavioral health of their customers differently than physical health,” said Rep. Sean Scanlon (D-Guilford), 2019 co-chair of the Insurance and Real Estate committee.