Health plans want the next federal mental health parity rule to do something regulators haven’t yet: show them what compliance looks like. The 2021 law called for illustrative examples of good compliance, and plans are still waiting for them, according to Debbie Witchey, president and CEO of the Association for Behavioral Health and Wellness.
ABHW represents the health plans that provide mental health and substance use benefits, including Optum and Aetna. Its members cover about 200 million lives.
Clarity on parity has been hard to come by. Ms. Witchey’s appointment as ABHW’s incoming CEO was announced the same day the 2024 parity rule came out. The ERISA Industry Committee filed a lawsuit in federal court in Washington, D.C., Jan. 17, 2025. Attorneys for the group argue the regulation exceeds the authority of HHS and the departments of Labor and Treasury. The Trump administration later delayed enforcement of the rule so it could write a new one.
Ms. Witchey, who joined ABHW after more than 20 years at a broader association and earlier work at a hospital system, said the timing meant she had to get up to speed on parity before she felt ready.
ABHW was not part of the lawsuit. But it had concerns about the rule’s workability and agreed some of its provisions were not in the law. One example was the term “meaningful difference,” which Ms. Witchey said does not appear in the law and left members confused about how it would be interpreted. ABHW asked that it be removed.
The association compiled a list of changes it wanted in a new rule and shared it with the Biden administration, then with the Trump administration. Ms. Witchey said ABHW’s priority is a final rule that achieves the goals of the parity law without being overly burdensome to administer.
Plans have told ABHW that compliance criteria and areas of focus vary depending on which enforcement official handles their case, which Ms. Witchey called confusing and burdensome. Federal regulators heard the same feedback and asked ABHW about it, she said.
The back-and-forth between regulators and plans has value up to a point, she said, and very few plans, none of them ABHW members, have been found out of compliance. But investigations can stretch on for years.
“Having those investigations go on for years and years and years — as a taxpayer personally, that doesn’t seem like a very good use of taxpayer dollars, nor is it a good use of health plan funds, because that money is devoted to that process, which is mostly administrative. At the end of the day, I’m not sure we’re getting the value out of that,” Ms. Witchey said.
She called a recent field assistance bulletin from the Employee Benefits Security Administration helpful because it narrows where enforcement should focus while a new rule is pending: utilization management, treatment exclusions and network adequacy, the areas the bulletin identifies as having the greatest impact on patients.
Still, Ms. Witchey said the bulletin is no substitute for the compliance examples ABHW wants to see when the new rule comes out.
The rules may be in flux, but Ms. Witchey said the law itself is still being enforced. Some groups that aren’t closely involved in the issue have argued otherwise, or that only states are enforcing it, she said, pointing to the annual report to Congress as evidence.
“If you look at the report to Congress, that’s just not the case. Enforcement is happening. It’s just they’re not enforcing those new provisions that are part of the lawsuit that aren’t necessarily going to be upheld,” Ms. Witchey said.
The Labor Department’s 2024 report to Congress credits its enforcement with ensuring comparable access to mental health and substance use disorder benefits for 7.6 million participants in more than 72,000 plans. The report also says more resources are needed to fully enforce the law. Ms. Witchey said that enforcement covers both the law and its 2021 provisions.
Resolving parity would free ABHW to turn to quality and outcomes, the focus she said the association’s leaders laid out when she interviewed for the job.
“When all this started, there weren’t really even mental health benefits being offered when the parity law passed. How do we move forward into: Are we actually helping people get better? Are the benefits that we’re offering helping people to function, feel better, whatever that might be?” Ms. Witchey said.
Healthcare has made big strides toward outcomes, integration and quality on the medical side, she said, and ABHW wants the same for behavioral health.
That work is already underway. ABHW is focused on quality in applied behavior analysis, or ABA, where cost is part of the picture.
“Budget is certainly a key piece of it. We can’t keep spending what we’re spending on things that maybe aren’t working, but we want quality to lead. And that, we think, will help with the cost concerns as well,” Ms. Witchey said.
The association is also starting an effort to examine quality standards in inpatient mental health centers for children and youth, an area Ms. Witchey said needs attention and that she does not know of anyone addressing systematically.
“There are a lot of different initiatives we have ongoing outside of parity, for sure. But we do feel like we need to get this parity thing resolved so we can focus our attention [on] these other issues,” she said.
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