ERISA rule change affects access to mental health care | EBA

This is the second in a series on ERISA at 50.

This year marks the 50th anniversary of the Employee Retirement Income Security Act (ERISA), which has helped ensure that millions of Americans and their families receive high-quality health and retirement benefits through their employers. Based on the 2020-2022 Census, 86% of private sector workers received employer-sponsored health insurance. ERISA only gets better with age.

The enactment of ERISA in 1974 was an important moment in expanding access to health care for Americans, which, at the time, focused primarily on medical and surgical care in addition to mental health treatment. Unfortunately, mental health remained a gray area in insurance coverage until 1996 when the Mental Health Parity Act (MHPA) became law.

It was subsequently expanded by the Mental Health Equity and Addiction Equity Act of 2008 (MHPAEA). The goal was to prevent group health plans and health insurance issuers that offer mental health or substance use disorder benefits from imposing benefit limits less favorable to mental health care than their medical or surgical packages. offered. The amendment did not require ERISA self-insured health plans to provide mental health and substance use disorder coverage to their beneficiaries. If they do, however, they must comply with MHPAEA, one of a series of federal laws that have affected ERISA plans since its inception half a century ago.

Read more: Substance use disorder is costing employers billions

Today is well documented that Americans are facing a mental health crisis. With one growing number of adults and children With a need for mental health and substance abuse disorder care, federal and state policymakers are looking for solutions. The importance of ERISA preemption in light of the application of the MHPAEA to self-insured health plans cannot be overstated. It allows employers to provide uniform and robust health care coverage to a multi-state workforce with the flexibility to pursue innovative benefit models while mitigating rising costs for employers and their workforce.

That’s why ensuring that the MHPAEA and its regulatory standards are enforceable is essential to preserving mental health and substance use disorder coverage for Americans who receive it through ERISA health plans.

Now, in the midst of this mental health crisis, a policy proposal threatens to destabilize the infrastructure for mental health and substance use disorder care for millions. Proposed changes to MHPAEA’s regulatory standards could lower the quality and safety bar for providers to join insurance networks. It can also mean less patient-centered treatment plans tailored to the needs of the individual seeking care—leading to over- or under-use of appropriate treatment options, including hospital care.

Read more: Employers want to support addiction recovery – and the federal government is ready to help

With Americans struggling, many agree that we need to increase the number of qualified mental health professionals in hospitals and clinics. Instead of new and costly regulations, our efforts should be focused on crisis prevention and faster mental health treatment. This is done by providing training to primary care physicians to better identify and treat mental health conditions. It includes allowing qualified and credentialed mental health providers to practice across state lines so patients can get treatment quickly. Rather than erecting barriers to access to care through telehealth, we should erect regulatory measures to encourage appropriate use of this care tool.

Finally, resources should be directed toward incentives and funding for long-term programs to encourage students and young physicians to join the mental health workforce. And politics must provide ways to retain the talented professionals who are already devoting their time to this cause.

Read more: Rethinking mental health in the workplace

ERIC (ERISA Industry Committee) is committed to working with regulators and all stakeholders to help identify workable policy solutions to ensure better patient access to mental health and substance use disorder treatment. Employers have responded and are committed to finding solutions.

It is essential that policymakers see the proposed MHPAEA rule change for what it is: A short-sighted attempt to fix a long-term problem. The best way to address America’s mental health crisis is to invest in our health care professionals and give them the tools to continue their good work for American patients.