APA Participates in Government Roundtable to Address Our Major Challenges

Over the last month, the national spotlight has continued to illuminate Americans’ need for mental health care, the challenges in meeting that need, and the public and private attention and commitment to addressing mental health. Our nationwide response to the mental health pandemic is underway, and with it, APA’s advocacy for psychiatrists, patients, and the integrity of our profession continues full force.

The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 is a key federal law aimed at ensuring that Americans have access to mental health benefits in their health insurance plans on par with other medical benefits. Specifically, MHPAEA prohibits health insurance plans from imposing limits on mental health benefits that are more restrictive than those for other medical benefits. While MHPAEA does not apply to every health plan in the United States (notable exceptions include most Medicare plans), it applies to approximately 2 million group health plans covering roughly 136.5 million Americans.

Yet while MHPAEA is a key tool in fighting mental health stigma by legislating the end of discriminatory benefits determination for people with mental illness, the details are far more complicated. Progress has been slow in achieving the promise of the law. One clear example of the work left to be done occurred this past January, when the Department of Labor requested that more than 100 health plans provide information pursuant to MHPAEA’s documentation requirements and found that not a single insurer’s submission met the statutory requirements (“White House Task Force Issues Report to Improve Parity Compliance”). This result is particularly concerning given that some version of MHPAEA has been in effect since 1996. We clearly have substantial work ahead in ensuring that every American has access to high-quality, evidence-based, and affordable mental health care.

Unfortunately, lack of compliance with required documentation is only the tip of the iceberg. APA, our members, and our patients are acutely aware of barriers to obtaining mental health care. Last month, Department of Labor Secretary Marty Walsh and Acting Assistant Secretary Ali Khawar invited APA representatives to participate in a roundtable discussion on mental health parity with representatives from sister mental health organizations. I was honored to represent APA at the meeting, especially given my personal experience with Secretary Walsh’s commitment to mental health when he was the mayor of Boston. As mayor, Secretary Walsh was a key supporter of mental health and substance use treatment and was open about his own recovery journey. In his current position, he has continued his work to advance all Americans’ access to mental health and substance use care.

The energy and spirit of collaboration at the meeting was palpable as leaders of mental health professional organizations and patient and family advocacy organizations shared their work, progress, challenges, and commitment to advancing the goal of providing mental health care to every American. Several themes regarding the work ahead for parity enforcement emerged. Stepped-up parity enforcement is possible, in part, due to funding appropriated by Congress as part of a large series of provisions on which APA members, including me, provided testimony this spring (“Incoming APA President Testifies Before House Subcommittee”). There were several specific areas highlighted for stepped-up enforcement. For example, several organizations focused on work that APA and others have conducted through “secret shopper” surveys in which survey workers called psychiatrists listed on insurance panels to check for actual availability and found that in numerous geographical locations—including major cities—networks are inadequate.

On the APA front, I presented three issues of particular concern to our members’ ability to provide care to patients: low reimbursement rates that cause network inadequacy, specifically asking whether insurers have been similarly reluctant to increase rates when networks are inadequate for other specialties; facility-based concurrent review practices by insurers that are often arbitrary, opaque, and divorced from transparent application of clinical progress metrics; and retrospective review of payments for office-based care that have left APA members—and their patients—facing uncertainty about payment for treatment long after appointments have occurred and even retroactive clawback of claims already paid.

The roundtable concluded with other measures that the Department of Labor could take through employers to advance mental health, including education about parity and the importance of mental health care to support the health and productivity of workers.

As we continue to advance our roadmap for the future this year at APA, there is no question that our focus on advocacy and interprofessional collaboration is making an impact. As always, please keep your ideas coming and join the conversation on Twitter, where you can follow me @Pres_APA! I’ll be back next month! ■