By Alison Mohr Boleware, MSSW
Please welcome our first guest blogger, Alison Mohr Boleware, MSSW, Policy Fellow at the Hogg Foundation for Mental Health. Mental health and substance use parity legislation is currently advancing through the Texas legislature. Alison provides a helpful primer on parity and the issues this legislation aims to solve. Yesterday, HB 10 passed the House and its companion bill, SB 860, was heard in a Senate committee. Now the House version heads to the Senate Business and Commerce Committee before a final vote on the Senate Floor. If the bill passes, HB 10 will then head to the Governor’s desk! Please follow the bill on the Texas Legislature Online.
Access to services is vital for mental health and substance use disorder recovery. Individuals with mental health and substance use conditions need access to evidence-based, quality services in a timely manner. When mental health and substance use disorder (MH/SUD) treatments are out of reach, recovery becomes out of reach. Unfortunately, individuals with mental health needs often face higher rates of denial for their mental health condition treatment when compared to physical health care.
Parity can play a big part of reaching recovery. Existing laws state that if a health plan covers mental health or substance use benefits, they must be covered at the same level as medical and surgical benefits, or at “parity”.
A Short History of Parity
Parity is not a new concept. The Mental Health and Addiction Equity Act (MHPAEA) passed in 2008 and was signed by President George W. Bush. As initially passed, MHPAEA required large employer plans (51+ employees) that cover MH/SUD benefits to cover those benefits at parity with medical and surgical benefits. In 2010, the Affordable Care Act (ACA) included minimal parity protections that extend parity to small employer plans and individual market plans, both inside and outside of the Health Insurance Marketplace.
Although existing parity laws are on the books, Texas has little enforcement authority over health plans. Currently, the Texas Department of Insurance only has the legal authority to regulate certain types of parity violations for large employer plans. This leaves out small employer plans and plans bought on the individual market.
What About Now?
Currently Texas only has the authority to regulate “quantitative treatment limitations” (QTLs) for large employer health plans. QTLs are numerical and include treatment limitations (i.e. number of visits or days in an inpatient setting) and financial requirements (i.e. co-pays and lifetime deductibles). However, many consumers experience violations related to “non-quantitative treatment limitations” (NQTLs) which the Texas Department of Insurance does not currently have the authority to regulate. NQTLs are non-numerical and include step-therapy for certain mental health medications (requiring the individual try a cheaper medication even though the physician’s first choice is a different medication), prior authorization for mental health or substance use-related services (requiring visit a physician to ensure that services are needed before going to see a mental health professional), and medical necessity criteria.
Parity compliance on both QTLs and NQTLs create more protection for consumers in need of services. This may sound like a good idea from a policy wonk or mental health provider perspective, but what does true parity compliance look like for consumers?
Texas has the opportunity to make a lasting impact on MH/SUD parity this legislative session. HB 10 by Chairman Four Price (SB 860 is the Senate companion by Senator Judith Zaffirini) would require Texas Department of Insurance to enforce parity compliance related to both QTLs and NQTLs for large employer, small employer, and individual market plans. Both bills would also create a Behavioral Health Access to Care Ombudsman at the Health and Human Services Commission, a position that would act as a support navigator for consumers, providers, and families. The bills would create a stakeholder workgroup dedicated to creating a parity plan for the state and require a one-time requirement of the Health and Human Services Commission and Texas Department of Insurance to compare their denials for MH/SUD services compared to physical health care services.
The opportunity is here. Now it’s up to legislators to decide if Texas will step up on mental health and substance use parity.
Will Francis, LMSW
Government Relations Director,
National Association of Social Workers,
Cossy Hough, LCSW
Clinical Assistant Professor, The University of Texas at Austin,
School of Social Work
Anna Stelter, LMSW, MPH
Health Policy Analyst
Texas Health Institute
Alison Mohr Boleware, MSSW
Mental Health Policy,