By: Bryan M. Dunton, Esq.

Unknown to many of us, celebrities suffer from mental health and substance use disorders just like anyone else. Recently, country music megastar Luke Combs openly discussed his struggles with obsessive compulsive disorder (OCD). Combs hopes that his discussion of the topic will reduce stigma that often comes with a mental health diagnosis. Taylor Swift has previously discussed her own struggles with an eating disorder for similar reasons. Before Robert Downey Jr. became Iron Man on the big screen, he suffered from substance use disorders for years before seeking treatment, ultimately becoming sober and remaining so to this day.

Barriers to mental health and substance use disorder treatment have existed in some form or another for quite some time, in part because of the aforementioned stigma. When Congress signed the Mental Health Parity Act (MHPA) 29 years ago, it was the first significant step towards addressing some of these roadblocks to care. The Mental Health Parity and Addiction Equity Act (MHPAEA) built upon the MHPA by prohibiting group health plans from imposing more restrictive non-quantitative treatment limitations (NQTLs) – non-numerical limits – on mental health or substance use disorder (MH/SUD) benefits compared to those placed on similar medical/surgical (M/S) benefits. The government’s reaffirmation that individuals need access to MH/SUD care has subsequently impacted benefit offerings.

The most important change, however, came only a few years ago when Congress signed the Consolidated Appropriations Act, 2021. This Act amended the MHPAEA to require NQTL testing that includes a comparative analysis for review of plan design, underlying plan and vendor policies and procedures, and de-identified aggregate claims data. For the first time, group health plans and their vendors were required to prove out their parity status.

In the four years since, we have seen this testing requirement trigger significant changes to how the self-funded health insurance industry perceives MH/SUD benefits. No longer an afterthought, MH/SUD benefits are often at the forefront of plan administrators’ minds when they make changes to plan design, attempting to avoid parity concerns.

So, how has this materially impacted people receiving benefits for MH/SUD conditions? Anecdotally, we have seen a significant focus on plan design changes to eliminate longstanding MH/SUD limitations that are more stringent than M/S limitations, particularly when plans have been unable to objectively justify their continued existence. For the past several years, we have received additional insight from the MHPAEA Reports to Congress that regulators submit annually. For example, we have seen exclusions relating to nutritional counseling, a core component of treatment for eating disorders, have been removed from 602 group health plans, impacting approximately 1.2 million plan participants. Additionally, the removal of exclusions of applied behavior analysis (ABA) therapy for the treatment of autism spectrum disorder (ASD) from many group health plans has increased access to this critical treatment for millions of plan participants over the last several years. This increased access to care helps children get the habilitative services they need, allowing parents to breathe a sigh of relief.

Health plans have also expanded access to medication-assisted treatment (MAT) and opioid treatment programs since enforcement efforts began in 2021. This development is critical since approximately 8.9 million people misused opioids in 2023 alone. Treatment and intervention for opioid use disorder can provide necessary help for an individual and help prevent the vicious cycle of abuse from inflicting further torment on their respective families.  

Another benefit of heightened parity in benefits design is that it reduces individual out-of-pocket spending as better MH/SUD benefits are being offered in-network. Group health plans are often also supplementing their networks with telemedicine for MH/SUD treatment to ensure there is robust access to care for the individuals who need it most.

Improving access to MH/SUD benefits also broadly improves the health and productivity of the country’s workforce. Prior to NQTL testing being required, the World Health Organization (WHO) released results of a study showing that every dollar invested in mental health saved four dollars due to improved worker productivity. National Institute of Health (NIH) research notes that the improvement in access to care continues to reduce workplace absenteeism and presenteeism. Maintaining a happy and healthy workforce is not just good for the individual; it is good for employers, too.

If you or someone you care about has ever lived with a mental health condition, or struggled with a substance use disorder, you know exactly how challenging it can be to feel like it is acceptable to seek treatment, let alone find the right provider for you. The good news is that there are more evidence-based treatment options available now than ever before. The MHPAEA, and its NQTL testing requirements, are important to ensure that services are made available and affordable for individuals when they need them the most. Just like celebrities openly discussing their personal mental health and substance use diagnoses, laws like the MHPAEA are helping to break down these barriers to care so everyday people can live normal, productive, and happy lives.