BRIEFING REPORT
JANUARY 2017
The Puzzle of Parity Implementing Behavioral Health Parity Tara Adams Ragone, J.D. John V. Jacobi, J.D.
Executive Summary People with mental illness and substance use disorders face many barriers to full participation in society. One significant barrier long has been the health insurance system’s disparate treatment of behavioral health care. Higher cost-sharing, disparate application of utilization review, and, most starkly, failure to cover behavioral health services have reduced this population’s access to needed care. In a previous Report of Seton Hall School of Law’s Sentinel Project, we described the history of insurance coverage of behavioral health services, and the potentially beneficial effects of federal and state statutory and regulatory efforts toward behavioral health parity. We also noted that, notwithstanding these efforts, lingering concerns remain: utilization and “medical necessity” decisions often are controversial, and clear dispute resolution remains elusive; consumers often are confused about when and to what extent parity law applies to coverage decisions; and regulators often struggle to oversee parity implementation. At a conference held at Seton Hall School of Law on September 16, 2016, academics, regulators, advocates, and plan representatives came together to share ideas on how parity implementation can be achieved. Uncertainty is the enemy of all interested parties, and each participant offered wisdom and experience to the efforts to move forward to fair and appropriate coverage of behavioral health services.
The Sentinel Project is supported by a generous grant from the Robert Wood Johnson Foundation. Copyright© 2017 Seton Hall School of Law Center for Health & Pharmaceutical Law & Policy. Permission is granted for reproduction of this Briefing Report, with attribution to the Center.