At the beginning of 2024, the nation continued to experience the impact of three declared public health emergencies with significant behavioral health implications: COVID-19, Mpox, and the opioid crisis. At the same time, three major national associations continued to highlight what they first described in 2021 as a “youth mental health crisis.” As we enter 2025, emergency declarations for two of these — Mpox and COVID-19 — have expired. But the opioid public health emergency, which preceded COVID-19, continues, as do long COVID-19, youth mental health needs, and other mental health and substance use disorder challenges. One issue that should not be overlooked as our nation confronts these current and ongoing challenges is the importance of behavioral health parity.
Lack of or inadequate health care coverage is one major reason many of those with substance use disorders and mental health conditions do not seek or cannot obtain treatment, according to the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Survey on Drug Use and Health. The Mental Health Parity and Addiction Equity Act (MHPAEA), enacted in 2008 and with important regulations issued in 2013 and 2016, and more recently in 2024, requires that when most health plans, including commercial health insurers and Medicaid and Children’s Health Insurance Programs, cover mental health conditions and substance use disorders they provide that coverage in a manner similar to that for other medical and surgical conditions. Parity requirements apply to financial (e.g., deductibles, copays), quantitative (e.g., visit numbers), and nonquantitative (e.g., prior authorization, medical necessity) terms and conditions. MHPAEA and parity, in general, have traditionally had strong bipartisan support, with Republicans and Democrats working together to ensure enhanced access for Americans to critical mental health and substance use disorder care. MHPAEA also helped spur additional requirements at the state level. Yet, despite bipartisan support, implementation continues to prove challenging at the federal and state levels and for health care payors and providers. Once informed about the concept of parity, Americans overwhelmingly support it.
Because of the complexity of the U.S. healthcare system and health coverage, three federal Departments, Labor, Health and Human Services (HHS), and Treasury, have important roles in parity compliance and enforcement, as do state regulators. Parity implementation requirements remain complex to implement and, at times, difficult to enforce. As well, some advocates note that parity remains inapplicable within Medicare. SAMHSA, the Department of Labor, and others have held Policy Academies for state officials and developed tools such as frequently asked questions materials to support parity implementation.
HHS and others have recognized that the need to improve health coverage, including parity, is important in the context of public health emergencies. The November 2022 HHS-led interagency Federal Plan for Equitable Long-Term Recovery and Resilience, for instance, includes a recommendation to “increase awareness of the importance of mental health and substance use treatment parity within Medicare, Medicaid, the insurance marketplace, and other health coverage mechanisms.” The 2022 HHS Roadmap for Behavioral Health Integration, on which work is continuing, also highlights parity implementation.
The COVID-19 Health Equity Task Force, which served under the auspices of the HHS Office of Minority Health, in its 2021 Final Recommendations and subsequent implementation report, likewise called for the federal government to “[i]mprove Medicare and Medicaid payment parity for behavioral health” including through ensuring resources for enforcement and adequate reimbursement.
Beyond HHS, the National Drug Control Strategy also urges attention to parity, as does a 2021 Bipartisan Policy Center report on behavioral health integration.
Bring back the Federal Parity Task Force.
Given such support and the continuing need for guidance and compliance efforts, one major step for the incoming Administration to elevate the importance of parity is to reinstate the Parity Task Force. In March 2016, then-President Barack Obama created the Mental Health and Substance Use Disorder Parity Task Force to “better ensure compliance with and implementation of requirements related to mental health and substance use disorder parity, and determine areas that would benefit from further guidance.” The Task Force included representatives from the Department of Health & Human Services (HHS) (e.g., the Centers for Medicare and Medicaid Services, SAMHSA), Treasury and Labor as well as the Office of National Drug Control Policy, Office of Personnel Management (which oversees Federal employee health plans) and the Departments of Veterans Affairs, Justice, and Defense. Led by HHS, this Task Force was charged with identifying gaps in parity guidance and best practices, obtaining input from health care providers, patients and consumer advocates, health insurers, and others, and developing a report with its findings and recommendations.
The Task Force’s work included federal sector discussions and public engagement efforts, including holding listening sessions and receiving written public comments. In October 2016, the Task Force issued its final report. This report noted several then-ongoing efforts by federal agencies and recommended additional guidance, educational efforts for policymakers and consumers, and additional compliance efforts.
Nearly nine years later, a new Federal Parity Task Force could reexamine the state of parity given such challenges as COVID-19, continued mortality and morbidity due to substance use disorders and mental health conditions, challenges for youth, older adults, and other populations, and the changed post-COVID legal and policy environment, including the growing use of telehealth to provide behavioral health services. The Task Force could once again seek input from advocates and members of the public and develop new and updated recommendations. With a high level of focus and support, a new Parity Task Force could help focus additional national attention on these important issues, drive parity implementation, and support the development of new tools, resources, training, technical support, and funding. Ultimately, this step could bring our nation closer to achieving the broadly supported goal of ensuring mental health and substance use disorder health patients receive the same scope, quality, and type of services as do 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.
