October 11, 2021

Earlier this year, the Texas Legislature designated October as Mental Health Condition and Substance Use Disorder Parity Awareness Month to educate Texans on behavioral health parity. The designation came as part of House Bill 2595, which the Legislature passed and Gov. Greg Abbott signed in June.

Behavioral health parity is when treatment of mental health conditions and substance use disorders is covered by health insurance plans just like treatment for other medical health conditions. Some health plans may not cover mental health or substance use disorder treatment, but if they do, state law requires that the coverage is equal to the coverage provided for treatment of other medical conditions.

For example, if someone’s health plan offers unlimited visits for a chronic condition like diabetes, then it might offer unlimited visits for a substance use disorder or mental health condition. Other aspects of coverage that may be equal or comparable include:

  • Inpatient services
  • Residential treatment services
  • Intensive outpatient services
  • Emergency care
  • Prescriptions
  • Copays and deductibles
  • Out-of-pocket maximums
  • Provider reimbursement rates
  • Geographic location of services

The HHS Ombudsman for Behavioral Health has seen an increase in parity cases as more Texans are asking questions about being denied access to mental health services.

“When the Legislature created the Ombudsman for Behavioral Health in 2015, it allowed our organization to focus on the needs of individuals that sometimes struggle to be heard clearly,” said Avril Hunter, the managing ombudsman for this program. “Our team prides itself on really trying to understand the concern before they move toward a resolution.”

When the HHS Ombudsman for Behavioral Health is contacted, its staff determine if there’s a potential parity violation and then help the client gather evidence to support their claim. While working in collaboration with the appropriate entity to investigate the complaint, they keep the client informed of any updates. If the complaint is determined to be a parity violation, the entity is expected to address the issue with the client.

“Parity is a simple concept, but in some ways that makes it hard for large organizations to address,” said HHS Ombudsman Joel Schwartz. “Parity Awareness Month gives the HHS ombudsmen an opportunity to share examples of their work with other HHS staff. And we hope that helps more individuals get resolution for their concerns.”

Texans who are having trouble getting mental health services should first contact their health plan and review their policy. If they still need help, they can call 800-252-8154 or visit the HHS Ombudsman for Behavioral Health webpage.