Payer group decries insurer fines in House mental health parity bill
Insurers argue the bill would 'weaponize' the Department of Labor by allowing it to sue an insurer for not covering mental health benefits.
Photo: John Baggaley/Getty Images
Major payer group the ERISA Industry Committee (ERIC), representing large employer plan sponsors, wrote a letter to the U.S. House of Representatives this week decrying legislation that would impose fines on insurers who don't follow mental health pay parity requirements.
The legislation in question, the Mental Health Matters Act, would allow the Department of Labor, or a plan member, to sue a group health plan or issuer for not covering mental health benefits, or to ensure the re-adjudication of claims and payment of benefits.
This, insurers argue, would "weaponize" the DOL.
"ERIC opposes this bill because it would significantly increase costs and reduce access to benefits," the group wrote. "Plan sponsors are committed to fulfilling their responsibilities as ERISA fiduciaries, which includes making recompense to individuals who were wrongly denied behavioral health benefits. The bill includes provisions that weaponize the Department of Labor (DOL) to sue employers rather than helping them come into compliance."
The group also said the bill proposes doubling the budget for the Employee Benefits Security Administration "to fund litigation against plan sponsors," which it contends would eliminate due process rights for employers and result in fewer funds dedicated toward providing behavioral health for plan beneficiaries.
On the expense side, ERIC said the bill would eliminate discretionary clauses, which grant a plan administrator the authority to interpret the plan document and resolve disputes in a way that adheres to DOL regulations. This, ERIC argued, would gum up the federal courts with expensive and duplicative proceedings.
WHAT'S THE IMPACT?
According to a fact sheet on the Mental Health Matters Act, which focuses largely on the mental health needs of youth and adolescents, the bill directs the Department of Education to award grants to build a pipeline of school-based mental health-service providers and to increase the number of mental health professionals serving in elementary and secondary schools in high-need areas. The DOE may also award grants to state educational agencies to recruit and retain school-based mental health-service providers at high-need public elementary and secondary schools.
The bill would require institutions of higher education to allow incoming students with existing documentation of a disability to access disability accommodations, and would require institutions to adopt more transparent policies around the accommodations process.
Among other components, the bill would require the Department of Health and Human Services to identify evidence-based interventions for the Head Start program and create a grant program to increase students' access to evidence-based trauma support and mental health services.
THE LARGER TREND
According to data from the Centers for Disease Control and Prevention, in 2021 more than 44% of students experienced persistent feelings of sadness or hopelessness, almost 20% seriously considered suicide, and 9% attempted suicide. In 2016, roughly one in six U.S. children aged 2-8 years had a diagnosed mental, behavioral or developmental disorder.
According to a 2019 ACLU study, no state met the student-to-social worker ratio of one social worker for every 250 students, as recommended by the National Association of Social Workers. Further, the national ratio of school psychologists per student in the 2020-2022 school year was one psychologist per every 1,162 students – more than double the ratio recommended by the National Association of School Psychologists.
In a recent report to Congress, the Departments of Labor, Health and Human Services and the Treasury found widespread violations of the Mental Health Parity and Addiction Equity Act of 2008 by group health plans and insurers who did not adequately maintain parity between mental health benefits and physical health benefits.
MHPAEA requires the Secretary of Labor to submit a report to the appropriate committees of Congress on compliance by group health plans - and health insurance coverage offered in connection with such plans - with MHPAEA's requirements.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
