Have you or someone you know paid out of pocket for mental or behavioral health treatment that should have been covered by health insurance, or shouldn’t have had due to cost? We want to hear from you.
Occupational health coverage is supposed to cover behavioral health issues, including mental health, the same way it covers anything else. It’s been the law of the land since 2008: no additional hurdles, prior authorizations, or stipulations if they’re not also part of regular coverage.
Congress asked the Department of Labor to survey providers. Marketplace took a look at what he found: many deficiencies and few providers that gave the government the requested information. In some cases, providers corrected deficiencies when the government found out.
Labor Secretary Marty Walsh told Marketplace’s David Brancaccio in an interview that the department will put a renewed focus on enforcing the law and fixing those flaws.
“And we are going to use all the tools that we have under the capacity that Congress gave us, and also with [the Department of Health and Human Services]to enforce this and move this law forward,” Walsh said.
“It is a priority for me because I have done this job for a long time. I’m someone who’s on the long haul [substance use] Recovery. And I also understand the importance of having mental health parity and substance use parity for people in America.”
The following is an edited transcript of their conversation.
David Brancaccio: What are you seeing here with this data? Employers still unwilling to make behavioral health as covered as anything else?
Marty Walsh: Well, certainly the report describes the department’s efforts to interpret, implement, and enforce the amendments to this law made by the [Consolidated Appropriations Act, 2021]. The report also includes information suggesting that health plans and health insurers are not achieving parity for mental health. [and] substance use disorder for those they cover. And it highlights the department’s recent emphasis on greater application of parity to correct those flaws. So yes, the answer is that it is not working as it should.
Brancaccio: Now your people looking into this had to send some of these parity reports back to the vendors because what? Were the reports not up to par or was the coverage they described not up to par?
Walsh: Yeah, well, I mean, [the Employee Benefits Security Administration] issued approximately 156 letters to plans and insurers requesting the required analysis. None of the analyzes reviewed to date have contained sufficient information on initial reception. So, in response to these initial requests, we issued 30 letters finding 48 initial determinations of noncompliance during the period covered by this report. So that’s where we are today.
Brancaccio: And in some cases, when health plans didn’t show parity and their people went back to the provider, did any of the providers fix the problems?
Walsh: Yes. Right now, I think between May and November 2021, [the Centers for Medicare & Medicaid Services] issued 15 letters requesting the required analysis. CMS, thus far, has issued 15 letters finding 16 initial determinations of noncompliance. So we are still working to get the information. I mean, at the end of the day, you know, these benefits should be covered. I spent my time before being secretary of labor: From 1997 to 2014, I was a state representative legislator from Massachusetts, and one of the, one of the issues, the main issues that I worked on as a legislator was mental health substance use. parity laws in Massachusetts. We have tens of thousands of people in our country who are struggling, and right now with the pandemic, probably more than that. And not having adequate coverage, but having better than adequate coverage, is really disappointing and, honestly, very dangerous for people in our country.
Brancaccio: Yes. Now, Congress requested this report from the Department of Labor. You are going to send it. But is there much you can do when you find that behavioral health coverage is getting some sort of second-class status?
Walsh: Yes. I mean, we’re going to keep moving forward. Let’s work on implementing this. We are working. I had a meeting earlier today, actually yesterday, Sunday, to talk about the parity law and make sure that we enforce it. I had another meeting this morning to talk about the law, not to prepare for this interview, but to talk about the law and how we enforce it. And we’re going to use all the tools that we have under the capacity that Congress gave us, and also with [the Department of Health and Human Services], to enforce this and advance this law. And not just push this law, push this coverage, honestly. The law is there, now it is the coverage we need.
Brancaccio: I mean, do you think you need more law enforcement powers? I know Congress would have to give it to you.
Walsh: Yes, potentially. We’re going to look and see what we need, but right now, I mean even the basics, what we have, I don’t want to describe it as basic, but with the skills that we have now, you know, insurance companies and employers should do better with this than they are doing today. You know, for businesses and insurers, it’s their taxpayers and their employees who need this coverage and their families, so we need to make sure they cover it. I mean, you know, this has been an ongoing conversation in our country for a long time, mental health parity. And, you know, there are challenges that we have to address in addition to being covered. But this must be a priority for insurance companies.
Brancaccio: Yes. I mean, one of those challenges is that people who are covered, those who are covered, have trouble finding providers, psychologists and other mental health professionals. There just aren’t enough of them out there. You can imagine that some companies, you know, if they’re acting in good faith, they might have trouble finding people for in-network coverage so they can show parity.
Walsh: One thing is happening here though, the [Joe] Biden-[Kamala] The Harris administration is certainly committed to addressing the needs of more mental health care professionals. There’s no question about that, that this industry hasn’t had, I don’t think, the support that it needed in the past. But historic investments are being made to better support critical workforces, and this is one of the critical workforces, thanks to the American Rescue Plan and the Provider Relief Fund. We’re working to strengthen the mental health care workforce by investing in strategies for a couple of things. One, build a portfolio of health professionals. Second, engage students early in their careers to create development with scholarship programs. Also looking at the first funding of postgraduate residency training for health professionals, [those are] important opportunities. And also looking at loan payment schedules. So all of these pieces are, you know, President Biden and Vice President Harris have laid that foundation, I would say about a year ago, last January, or it happened in March, but last year when it happened. And we’re working to make sure this conduit is there. And then we’re also going to have to, I think, be really intentional about working with hospitals. There’s also a lack of… I’m from Boston, and honestly, there’s a lack of beds in a lot of the facilities across the country, and for adolescent care there are fewer beds as well.
Brancaccio: But getting back to this central parity thing, I mean, you walk in as secretary of labor, the law has been on the books for 14 years, you must be saying to yourself, “Are they still trying to fix this?”
Walsh: Well, yes, I think that’s about it. And then I’m not sure where the priority was made. But certainly, when the president asked me to be secretary of labor, I, before that, was under investigation and was looking on the website of the Department of Labor. And if you look at the website, the penultimate bullet point was mental health parity. And for me, it’s a priority for me because I’ve done this job for a long time. I am someone who is in long-term recovery. And I also understand the importance of having parity in mental health and parity in substance use for people in the United States. It’s a priority of mine now, and that’s why, and also, with HHS, working with the Secretary [Xavier] Becerra: We’re making sure this remains a priority here. Because, aside from the fact that we’re looking at, I think the numbers are 1 in 3 Americans that have some kind of potential problem due to COVID – we need to make sure people are covered. And when I say “covered”, covered to get the health you deserve, not just covered. I mean, a lot of insurance will say, “You’re covered. We have in our documents that it is part of the portfolio.” You’re more than covered, you’re actually getting good, solid care that people deserve too.
The Department of Labor says that people who believe they have been subjected to a mental health parity violation can contact one of their Employee Benefits Security Administration benefits advisors for help on 1-866-444-3272 or visit https://www.dol.gov/agencies/ebsa/about-ebsa/ask-a-question/ask-ebsa.
