On December 1, the U.S. Senate Finance Committee released draft legislation that would improve mental health parity in Medicare and Medicaid to ensure mental and physical health care are covered equally by health insurance.

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law which requires comprehensive standards for equitable coverage of mental health and substance use disorder treatment and coverage of medical/surgical treatment. The 2010 Affordable Care Act expanded the reach of the MHPAEA by requiring most health plans to cover mental health and substance use disorder care as well as expanding the scope of MHPAEA to reach smaller insurance plans. Despite these legislative advancements, there are still forms of insurance such as Medicare, certain state Medicaid programs, Veterans Administration or short-term limited duration health plans that still place limitations on mental health coverage. Additionally, federal laws do not require parity in reimbursement rates and consequently, Americans continue to face cost barriers for mental health services.

Some of the policies in the discussion draft include:

• Strengthening the accuracy of provider directories in Medicare and Medicaid so patients have more information on accessing care, especially from behavioral health professionals.
• Directing the Government Accountability Office (GAO) to examine Medicare enrollee cost-sharing and utilization of behavioral and non-behavioral health services
• Directing GAO to report on Medicaid payment rates for behavioral health compared to other medical services  
• Requiring Medicare to provide guidance to health care providers detailing hospitalization program services for beneficiaries with substance use disorder.

The full text of the discussion draft is available here. 

The draft legislation is the final part of a five-part series of legislative drafts that Senate Finance Committee has released as a part of a bipartisan behavioral health initiative. The other parts of the initiative focus on telehealth, youth mental health, mental health workforce and behavioral health care integration into physical health care systems.

NACo recently sent a letter signed by a bipartisan group of nearly 150 county elected officials calling on Congress to pass key county priorities in an end-of-year behavioral health legislative package in the Fiscal Year (FY) 2023 omnibus or any other legislative vehicle. Counties support the policies included in Senate Finance’s discussion drafts, particularly bolstering the behavioral health workforce, expanding local crisis response capabilities through Medicaid and enforcing equal coverage of mental health and substance use disorder.

ADDITIONAL RESOURCES

• NACo Blog: Nearly 150 County Officials Sign-Onto NACo’s Behavioral Health Advocacy Letter to Congress
• Behavioral Health Matters to Counties
• NACo Policy Brief: Enhance Counties' Ability to Prevent and Treat Mental Illness and Substance Abuse Disorders