Proposed legislation aimed at strengthening mental health parity enforcement has ignited debate among insurers, payers, and behavioral health advocates. The Mental Health Matters Act would give the U.S. Department of Labor (DOL) expanded authority to enforce provisions of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. In addition, the legislation would make it easier for individuals to sue insurers over behavioral health claims and include measures supporting school-based mental health initiatives. These changes could have major implications for insurance compliance behavioral health in the U.S.
Proponents of the bill argue that it adds teeth to parity legislation, which has historically been loosely enforced and inconsistently applied. Mental health advocates believe that stronger enforcement of parity will help ensure mental health and substance use disorder benefits are treated equally to medical and surgical benefits. Insurers and payers, however, warn that additional penalties may be excessive, especially since existing measures already aim to ensure insurance compliance behavioral health.
Industry Calls for Clarity Before Additional Penalties
Maeghan Gilmore, vice president of government affairs at the Association for Behavioral Health and Wellness (ABHW), emphasized that clear guidance is essential before new enforcement mechanisms are imposed. “Our request from ABHW member companies has been, ‘Let’s get the implementation of the CAA [Consolidated Appropriations Act of 2021] provisions done with and [get] clear, comprehensive guidance before we move into adding more enforcement mechanisms,’” she said.
ABHW, founded in 1994, represents payers managing behavioral health benefits and advocates for federal policy that promotes accessible and equitable mental health and addiction care. Gilmore stressed that robust compliance tools—such as complex benefit analysis templates and de-identified examples of violations—would help payers improve insurance compliance behavioral health and ensure adherence to federal standards.
Pamela Greenberg, ABHW president and CEO, noted that insurers already face significant consequences for noncompliance. “The DOL can publish the names of insurers failing to meet parity regulations,” she said. “That alone is actually a huge punishment. In addition, if they are found not compliant, they have to notify their customers and all beneficiaries of that insurance plan, which obviously is huge.” Monetary fines also exist: MHPAEA violations can result in breach of fiduciary duty claims under ERISA and IRS penalties of $100 per covered individual per day. These enforcement measures are part of the framework designed to ensure insurance compliance behavioral health across the industry.
Federal Oversight Highlights Parity Gaps
Several federal agencies have studied the state of behavioral health parity. In January, the DOL, HHS, and the Treasury Department submitted a report to Congress highlighting ongoing parity gaps. The report found that many health insurance plans fail to deliver equitable coverage for mental health and substance use disorder benefits, which underscores the importance of insurance compliance behavioral health.
U.S. Secretary of Labor Marty Walsh emphasized the need for enforcement. “The report’s findings clearly indicate that health plans and insurance companies are falling short of providing parity in mental health and substance-use disorder benefits, at a time when those benefits are needed like never before,” Walsh said.
Legal experts, including Jena Grady of Nixon Peabody, note that while the DOL has increased its investigatory capabilities, its enforcement powers remain limited. The Mental Health Matters Act would give the DOL the authority to impose post-civil monetary penalties directly on plan sponsors and administrators, a step that could strengthen insurance compliance behavioral health nationwide.
Historical Context: Why Parity Enforcement Matters
Behavioral health parity has long been a critical issue. MHPAEA, passed in 2008, requires that mental health and substance use disorder benefits be comparable to medical and surgical benefits. However, enforcement has often been inconsistent, and cases like Wit v. United Behavioral Health have highlighted how insurers can develop rules that restrict access to care. Strengthening insurance compliance behavioral health is central to ensuring patients receive fair coverage.
Previous administrations recognized the enforcement gaps. Reports noted parity violations but lacked tools for meaningful enforcement. The Biden administration aims to close these gaps, empowering the DOL to ensure that insurers follow federal parity standards, which would further improve insurance compliance behavioral health.
Broader Provisions Beyond Parity Enforcement
The Mental Health Matters Act also focuses on school-based mental health initiatives. Key provisions include:
- Recruiting and retaining qualified mental health providers in schools
- Expanding student access to trauma-informed programs
- Enhancing opportunities for students with disabilities to pursue higher education
These measures highlight a broader vision for supporting behavioral health and reinforcing insurance compliance behavioral health in educational settings, ensuring that care extends beyond traditional clinical environments.
Political Landscape and Next Steps
The Mental Health Matters Act passed the U.S. House of Representatives with strong Democratic support and faces Republican opposition in the Senate. The legislation is supported by the Biden administration, which sees it as essential to strengthening parity enforcement and improving accessibility of mental health and substance use disorder treatment.
Industry stakeholders, policymakers, and legal experts are closely monitoring the bill’s progress. Its passage could redefine insurance compliance behavioral health, improve access to treatment, and increase accountability for insurers across the nation.
Conclusion
The debate over the Mental Health Matters Act reflects a broader challenge in the U.S. health care system: balancing the enforcement of parity laws with clear expectations for insurers. While the legislation promises stronger enforcement and better access to care, insurers emphasize the need for clear guidance and comprehensive tools to meet parity requirements. If enacted, the Mental Health Matters Act could transform insurance compliance behavioral health, strengthen legal enforcement mechanisms, and expand support for behavioral health initiatives in schools, ultimately benefiting millions of Americans.
