How this payer achieved mental health parity accreditation

Mental health parity key imperative for payers

Mental health parity refers to " the equal treatment of mental health conditions and substance use disorders in insurance plans," according to the National Alliance on Mental Illness. "When a plan has parity, it means that if you are provided unlimited doctor visits for a chronic condition like diabetes then they must offer unlimited visits for a mental health condition such as depression or schizophrenia."

Mental health parity recently became a legal mandate for group health plans like Blue Cross and Blue Shield of Minnesota. Although the Mental Health Parity and Addiction Equity Act (MHPAEA) was passed in 2008, CMS released final rules implementing the law in September 2024.

The final rules sought to fortify the intent behind MHPAEA, being that mental health parity has not always meant equal access to high-quality mental health or SUD treatment.

"However, parity doesn't mean that you will get good mental health coverage," NAMI says on its website. "Comprehensive parity requires equal coverage, not necessarily 'good' coverage. If the health insurance plan is very limited, then mental health coverage will be similarly limited even in a state with a strong parity law or in a plan that is subject to federal parity."

Hart acknowledged that mental health parity can be hard because it has historically been difficult to interpret federal regulations.

"There hasn't always been a consistent interpretation of what constitutes parity compliance and what doesn't," he explained. "Anytime there's inconsistency or differing interpretations, it makes it difficult for a payer to know exactly how to be compliant."

In light of that, Hart and his team at Blue Cross and Blue Shield of Minnesota set their sights on even stricter compliance that they thought to be federally mandated. Ideally, gold-standard accreditation would help them navigate any ambiguity they might otherwise face.

Achieving mental health parity accreditation

Hart's team had to ask itself how it would navigate the parity final rule, he recalled.

"We knew we were in an environment where there was inconsistency and then uncertainty about what was going to happen with the parity final rule," Hart noted. "The question we asked ourselves was, 'Is there a standard out there that we could achieve that we felt went even beyond federal parity rule and represented in essence a gold star?'"

That gold standard turned out to be URAC's mental health parity accreditation.

"We believe that it represents a consistent understanding of what constitutes parity adherence compliance," Hart said. "We believe that it represents a level of scrutiny that is significant and really was an opportunity for us to check ourselves to make sure that we were performing at the level we believed we were, and to have an external objective evaluator look at us and make that determination rather than us making it for ourselves."

Achieving URAC's accreditation wasn't easy, but it wasn't intended to be. After all, Blue Cross Blue Shield of Minnesota had wanted the accreditation to go beyond any federal regulations in an effort to cover their bases. According to Yvette Johson, the director of Mental Health Parity at Blue Cross Blue Shield of Minnesota, the accreditation process required rigorous analysis.

"The accreditation process required us to provide detailed analyses for specifically identified non-quantitative treatment limitation types, as well as two additional ones selected by URAC," Johnson said in an emailed statement. "Additionally, we were required to demonstrate compliance with 13 specific standards assessed during the accreditation."

But it wasn't just Blue Cross Blue Shield of Minnesota's controls and oversight that mattered during the URAC review. URAC looked into how the payer oversees and ensures that its delegated vendors operate in a way that complies with parity rules, Johnson added.

"Well, there's no question that it's a considerable undertaking," Hart remarked. "But as an organization, our commitment to parity and access made that process of it easier for us."

Notably, Blue Cross Blue Shield of Minnesota has a dedicated team that exclusively attends to parity requirements. These professionals focus on member needs and continuously evaluate every aspect of the organization to ensure it is fulfilling mental health parity commitments, Hart explained.

"It does involve significant data analysis," he noted. "It does involve significant work in terms of establishing the governance and oversight structure that is necessary. There's a lot of work involved in reviewing our processes and our policies. It's very time-consuming, but from our perspective, also very worth it. So, having that dedicated team of individuals really made this an easier lift for us."

It's that team's very existence -- and his own professional role focusing on mental health parity -- that truly fortifies Blue Cross Blue Shield of Minnesota's commitment to mental health parity, Hart stressed.

While there are certainly key regulatory requirements the health plan wants to meet, Hart emphasized its focus on providing good healthcare to members. That means embedding parity into all aspects of the organization.

"It is a federal law, but for us, it's so much more than that," Hart concluded. "Parity is really about equal access for members. It's about getting our members the access to behavioral healthcare they need without barriers, without inappropriate limitations."

Sara Heath has reported news related to patient engagement and health equity since 2015.