With federal agencies preparing to update parity regulations and Congress considering reforms, our new report explains existing parity requirements, including who they apply to and how their enforced, and highlights key policy issues raised by regulators and advocates that could be addressed in the future.
Those issues include:
- Simplifying parity standards to make it easier for apples-to-apples comparisons between behavior health and medical benefits needed to assess compliance.
- Taking a closer look at how insurers are using medical necessity criteria to make behavior health coverage decisions that potentially could affect people’s ability to access care.
- Developing enforceable standards to determine the adequacy of provider networks across the full spectrum of behavioral health needs from screening to inpatient treatment, including the potential and limits for telehealth providers to provide coverage.
- Evaluating enforcement tools to allow regulators to better assess and enforce parity compliance, potentially including additional data-reporting requirements or incentives for employers or other plan sponsors to monitor their behavioral health coverage.
In weighing possible changes to address such issues, other factors to consider include the potential increased costs resulting from expanded behavior health coverage as well as an existing workforce shortage and other structural problems.
The brief is part of KFF’s ongoing work examining what consumers and patients face as they navigate the health care system, including financial barriers, administrative complexity, lack of transparency, and problems accessing providers.