Opioid Crisis: At the start of 2024, the nation was still grappling with three public health emergencies that had significant behavioral health implications: COVID-19, Mpox, and the opioid crisis. Simultaneously, three major national associations continued to emphasize a “youth mental health crisis” initially declared in 2021. As we step into 2025, emergency declarations for Mpox and COVID-19 have expired. However, the opioid public health emergency persists, alongside long COVID-19, youth mental health challenges, and other behavioral health issues. In confronting these ongoing challenges, the importance of behavioral health parity must not be overlooked.
The Role of Health Care Coverage in Accessing Treatment
According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health, a major reason many individuals with substance use disorders and mental health conditions do not seek or cannot obtain treatment is the lack of or inadequate health care coverage. The Mental Health Parity and Addiction Equity Act (MHPAEA), enacted in 2008 and further refined by regulations in 2013, 2016, and 2024, mandates that most health plans provide mental health and substance use disorder coverage comparable to that for other medical and surgical conditions. These parity requirements encompass financial aspects (e.g., deductibles, copays), quantitative terms (e.g., number of visits), and nonquantitative terms (e.g., prior authorization, medical necessity). Despite strong bipartisan support for MHPAEA, its implementation at both federal and state levels remains challenging for health care payors and providers.
Complexity in Implementation and Enforcement
The U.S. healthcare system’s complexity involves three federal Departments—Labor, Health and Human Services (HHS), and Treasury—in parity compliance and enforcement. State regulators also play a crucial role. The implementation and enforcement of parity requirements are often complicated. Some advocates note that parity does not yet extend to Medicare. SAMHSA, the Department of Labor, and other organizations have provided tools such as FAQs to aid parity implementation. Recognizing the importance of health coverage, including parity, is essential in the context of public health emergencies. For example, the 2022 HHS-led interagency Federal Plan for Equitable Long-Term Recovery and Resilience recommended increasing awareness about the importance of mental health and substance use treatment parity within various health coverage mechanisms. Opioid Crisis
Recommendations from the COVID-19 Health Equity Task Force
The COVID-19 Health Equity Task Force, operating under the HHS Office of Minority Health, in its 2021 Final Recommendations, emphasized improving Medicare and Medicaid payment parity for behavioral health, which includes ensuring resources for enforcement and adequate reimbursement. The National Drug Control Strategy and a 2021 Bipartisan Policy Center report also highlighted the need for attention to parity.
Reinstating the Federal Parity Task Force
One significant step the incoming Administration could take to elevate the importance of parity is reinstating the Parity Task Force. Initially created by President Barack Obama in 2016, the Mental Health and Substance Use Disorder Parity Task Force aimed to ensure compliance with parity requirements and identify areas needing further guidance. This Task Force included representatives from HHS, Treasury, Labor, and other relevant departments. It engaged in federal sector discussions and public input through listening sessions and public comments, culminating in a final report with findings and recommendations.
Nearly nine years later, a renewed Federal Parity Task Force could reexamine the state of parity, addressing challenges such as COVID-19, ongoing substance use disorder and mental health condition crises, youth and older adult needs, and the expanded use of telehealth for behavioral health services. This Task Force could once again solicit input from advocates and the public, developing updated recommendations to enhance parity implementation, support new tools and resources, and ultimately ensure that mental health and substance use disorder patients receive equivalent care to those with other medical conditions.
Mitchell Berger is a public health advisor. The opinions expressed are solely those of the author and should not be imputed to any other individual or to any public or private entities.
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Source: Original Article