#HARTFORD – After hearing continued complaints from constituents living with mental illness and substance use disorders about equal access to treatment, U.S. Senator Chris Murphy (D-Conn.) led a group of 17 senators on Monday in urging the White House Mental Health and Substance Use Disorder Parity Task Force to consider taking a specific set of actions – including conducting random audits and establishing an online public portal – to improve compliance with parity laws and ensure that Americans receive equal access to behavioral health care. In a letter addressed to Cecilia Muñoz, Director of the Domestic Policy Council at the White House, the senators outlined the most common issues their constituents experienced while attempting to access mental health treatment, and recommended that the White House consider taking action on six specific proposals to address some of the most significant barriers to mental health parity.

“We are writing to applaud the President for establishing the Mental Health and Substance Use Disorder Parity Task Force and to inform the Task Force recommendations,” wrote the senators. “Given that mental health parity is still not a reality for our constituents, we ask that you consider the need for the following [proposals] when developing your recommendations. We believe the steps outlined…would address some of the most significant barriers to equitable access to mental health and substance use disorder treatment.”

U.S. Senators Elizabeth Warren (D-Mass.), Tammy Baldwin (D-Wis.), Richard Blumenthal (D-Conn.), Sherrod Brown (D-Ohio), Ben Cardin (D-Md.), Joe Donnelly (D-Ind.), Dick Durbin (D-Ill.), Al Franken (D-Minn.), Kirsten Gillibrand (D-N.Y.), Heidi Heitkamp (D-N.D.), Angus King (I-Maine), Amy Klobuchar (D-Minn.), Ed Markey (D-Mass.), Patty Murray (D-Wash.), Jack Reed (R.I.), Bernie Sanders (I-Vt.), and Sheldon Whitehouse (D-R.I.) joined Murphy in sending the letter.

The full text of the letter is below:

Cecilia Muñoz

Director, Domestic Policy Council

The White House

1600 Pennsylvania Ave, NW

Washington, DC 20500

Dear Ms. Muñoz,

We are writing to applaud the President for establishing the Mental Health and Substance Use Disorder Parity Task Force and to inform the Task Force recommendations.

The Mental Health Parity and Addiction Equity Act (MHPAEA) was signed into law by President Bush in 2008 after lengthy public and congressional debate. This important legislation was enacted to ensure that health insurance plans cover and provide access to behavioral and physical health care treatment equally. However, we continue to hear from our constituents that parity is still not a reality for many individuals living with mental illness and substance use disorders today. Specifically, the most common issues brought to our attention are outlined below:

Lack of disclosure by health plans on the development and application of non-quantitative treatment limitations (NQTLs). Parity compliance testing cannot be performed on coverage limitations such as prescription drug formulary design, medical management, and restrictions based on facility type or provider specialty without this information. For example, in order to determine whether a plan is in compliance with the law, consumers and providers may request medical management criteria and information on how this criteria is developed and applied to substance use/mental health disorders and medical/surgical disorders. We have been made aware of hundreds of such requests by authorized providers that have gone unanswered. In these cases, the plans ignored both the parity law challenge and the request for disclosure of documents and information for both behavioral and medical benefits pertaining to parity compliance and relevant to the claim.

Poor oversight, enforcement, and coordination by federal and state regulators to ensuring that plans are in compliance with MHPAEA. We are hopeful that recently released sub-regulatory guidance will improve the availability of essential information for performing parity compliance testing, but believe more can be done. 

Confusion about where and how to file a complaint given the myriad of federal and state agencies with implementation and enforcement responsibilities over MHPAEA.

Inconsistent application of mental health parity in the Federal Employees Health Benefits Program (FEHBP).  Although there was not a specific statutory requirement applying MHPEA to FEHBP plans, FEHBP explicitly adopted MHPAEA and its rules in OPM issued carrier letters beginning November 2008 and beyond.  We have received reports that over 2/3 of inpatient rehabilitation treatment is being denied based on medical necessity with no comparable action on the medical side. These denials are continuing despite data from a November 2013 report to HHS that found that despite parity and increases in SUD diagnoses, there were no different rates of initiation and engagement in treatment under parity and total plan spending per user and average utilization of substance use disorder services did not change. In addition, residential levels of care and broadly defined residential treatment facilities are being excluded from plan coverage altogether. 

Given that mental health parity is still not a reality for our constituents as outlined above, we ask that you consider the need for the following when developing your recommendations:

·         An enforcement strategy that ensures compliance with MHPAEA by both state and federally regulated plans, including tactics such as random audits and public disclosure of de-identified results of investigations into parity violations to allow market corrections, before the end of 2016.

·         A consumer parity portal website that would allow consumers to easily access all publicly available parity information and submit complaints to a central online clearinghouse.

·         Collection of information on the rates and reasons for denials by group health plans for claims of outpatient and inpatient mental health and substance use disorder services by federal regulators.

·         Requirements for health plans to file a compliance plan with regulators regarding which NQTLs are used.

·         Requirements for health plans to provide information upon request to health care providers and consumers describing how the plan develops and applies NQTLs to mental health/substance use disorders and medical/surgical disorders covered by the plan.

·         Requirements for health plans to disclose a comprehensive list of the types of NQTLs that could be applied to the mental health/substance use disorders in the summary of benefits documents provided to policyholders.

Lastly, we appreciate the efforts you’ve taken to reach out and engage key stakeholders, such as mental health and substance use providers, patients and advocates as you develop recommendations.

We believe the steps outlined above would address some of the most significant barriers to equitable access to mental health and substance use disorder treatment. Thank you very much for your attention to this important matter and we look forward to your response.

Sincerely,

U.S. Senator Chris Murphy

U.S. Senators Elizabeth Warren

U.S. Senator Tammy Baldwin

U.S. Senator Richard Blumenthal

U.S. Senator Sherrod Brown

U.S. Senator Ben Cardin

U.S. Senator Joe Donnelly

U.S. Senator Dick Durbin

U.S. Senator Al Franken

U.S. Senator Kirsten Gillibrand

U.S. Senator Heidi Heitkamp

U.S. Senator Angus King

U.S. Senator Amy Klobuchar

U.S. Senator Ed Markey

U.S. Senator Patty Murray

U.S. Senator Jack Reed

U.S. Senator Bernie Sanders

U.S. Senator Sheldon Whitehouse