October 17, 2023
Secretary Janet Yellen
Department of the Treasury
1500 Pennsylvania Avenue, NW
Washington, DC 20220
Acting Secretary Julie Su
Department of Labor
200 Constitution Avenue, NW
Washington, DC 20210
Secretary Xavier Becerra
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
RE: Requirements Related to the Mental Health Parity and Addiction Equity Act (88 FR 51552)
Dear Secretary Yellen, Acting Secretary Su, and Secretary Becerra:
On behalf of the CEO Members of Business Roundtable, who, collectively, lead companies that employ more than 20 million individuals, we thank the Department of the Treasury, the Department of Labor, and the Department of Health and Human Services (collectively, the tri-agencies) for the opportunity to comment on the proposed rules to further implement the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
Business Roundtable members recognize that employers play an important role in providing mental health and substance use disorder (MH/SUD) coverage and care. In 2020, 90 percent of employers provided employee assistance programs for mental health services and 86 percent provided mental health coverage. Employers are prioritizing access to meaningful MH/SUD care for their employees by providing a broad set of tools, such as employee assistance programs, comprehensive health benefits, direct access to care and community-based programs. In addition, plans and issuers are actively working to help expand coverage and connect patients with the right providers. According to a survey of plans and issuers, over the last three years, the number of in-network behavioral health providers grew by an average of 48 percent, with 89 percent of plans actively recruiting more mental health care providers for their networks, and 78 percent of plans increasing payments to providers.
Employers know that investments in quality mental health services are important to employee satisfaction, retention, absenteeism and economic output. Research shows that 91 percent of employees believe that their employers “should care about their emotional health,” and 85 percent say that “behavioral health benefits are important when evaluating a new job.”
A recent survey demonstrated that employees who rate their mental health as fair or poor are estimated to miss about four times more work than others. The study conservatively estimates the cost of this missed work time to be “$340 per day for full-time workers and $170 per day for part-time workers;” annually, the lost productivity is estimated to cost the economy $47.6 billion.
Furthermore, during the COVID-19 pandemic, many employers made proactive changes to their mental health coverage to better serve employees struggling with mental health needs, including expanded access to existing services and new employee assistance programs. For example, many started offering mental health services via telemedicine; as many as 96 percent of employers could offer tele-mental health services by the end of 2023.
U.S. spending on mental health with private insurance surged during the pandemic, according to a new study published in the scientific journal JAMA Health Forum. The study reviewed diagnosis codes for anxiety disorders, major depressive disorder, bipolar disorder, schizophrenia and post-traumatic stress disorder from claims from about seven million adults from January 2019 to August 2022 by the RAND Corporation and Castlight Health researchers. Most notably, the study concluded that treatment across the board—in person and online—increased during the pandemic. Spending on mental health services jumped 53 percent from March 2020 to August 2022 and mental health services use increased 22 percent from March to December 2020, the acute phase of the pandemic. By August 2022, mental health service use was 39 percent higher than prior to the pandemic.
Payers have significantly increased access to MH/SUD services during the pandemic. Spending pre-pandemic was about $2.3 million per 10,000 beneficiaries per month. It increased to about $3.5 million after the acute period of the pandemic. Similarly, telehealth utilization for MH/SUD services increased by 1,019 percent during the acute phase of the pandemic compared to the pre-pandemic era. By the post-acute pandemic period, telehealth utilization had increased by 1,068 percent, while in-person visits increased by 2.2 percent compared to the pre-pandemic era.
Business Roundtable members agree with the tri-agencies’ assessment that more needs to be done to increase compliance with the MHPAEA, however, this is only one element of ensuring employees have the MH/SUD benefits and care their families need. In determining if companies are making meaningful investments in MH/SUD coverage and care, a holistic approach is needed, one that takes into consideration the other ways in which employers and their third-party administrators (TPAs) are providing MH/SUD services and supports.