Ensuring parity in Oklahoma: Leveling the playing field for mental health

January 1, 2020

Without parity, too many Oklahomans are left behind.

  • Oklahomans can’t get access to network care for mental health. Data show they must go out of network for outpatient care 9X more often than for other health services, and 7X more for inpatient care. These disparities have doubled since 2013.
  • Provider reimbursements are skewed against mental health, limiting access and provider availability. Office visits for primary care in Oklahoma are reimbursed 27% higher than for similar mental health visits. That disparity is worse than the U.S. average (23%).
  • The situation is worse for children. Disparities in out-of-network utilization are greater for children than for adults, saddling families with increased cost and poor access.
  • Providers and people needing treatment regularly report ever-changing and burdensome hurdles to accessing care, saddling families with extra costs and delays.
  • Luckily, Governor Kevin Stitt signed SB 1718 in the spring of 2020 mandating insurers to comply with insurance parity in Oklahoma.
  • However, parity laws are difficult to implement and enforce.

What is Parity?

Parity is the guarantee that mental health conditions and substance use disorders will be treated the same as other medical condition for the purpose of insurance coverage. For example, if an insurance plan has parity, mental health and substance abuse coverage wouldn’t have any limitations that coverage for other medical conditions wouldn’t. Limitations include network adequacy, co-pays, deductibles and others.  Parity requires equal coverage, not good coverage. Without parity, Oklahomans face barriers to accessible and affordable mental health and substance use treatment.

A Short History of Parity

Federal Action

George W. Bush signed the Paul Wellstone and Pete Domenici Mental Health Parity Act (MHPAE) into law at the end of 2008. Its mission was to ensure that mental health and substance use treatments were covered at parity with medical and surgical benefits. The Affordable Care Act, signed into law in 2010 pushed parity efforts forward. Before the ACA, 1/3 covered in the individual markets has no access to substance use treatment and around 20 percent had no coverage for mental health benefits. The author of the ACA were thinking of parity when they included mental health and substance use treatment benefits in the category of “Essential Health Benefits,” they also extended federal parity protections, and increased access to quality care.

State Action

MHPAEA doesn’t prevent states from passing and enforcing more strict parity language. In 1999, Oklahoma passed a parity law after a 3 year long fight. When passed, it exceeded the mandate of the MHPA of 1996 in an attempt to close some of its loopholes at a state level. S.B. 1718, Oklahoma’s most recent action mandates parity and attempts to ensure enforcement of state and federal parity laws.

Next steps

Telehealth Payment Parity

Covid-19 has accelerated the accessibility and adoption of tele-mental healthcare and statute needs to be modernized to ensure that providers are reimbursed at a rate not less than they would be reimbursed if services were provided in-person, when diagnostically appropriate. As a response to Covid-19, many private insurers instituted policies that expanded, encouraged and reimbursed tele-mental health services and this bill cements those changes into law. Ensuring reimbursement parity beyond Covid-19 allows rural practitioners to keep their doors open while also allowing rural Oklahomans access to mental health care at an unprecedented level.


One of the largest complaints of parity advocates lies with the lack of enforcement on the federal level. State have largely taken it upon themselves to mandate enforcement on a state level. Enforcing parity requires the creation of new regulations, agencies monitoring compliance, assisting consumer who believe there may be a violation, and conduction investigations.

Although the federal government has attempted to ensure compliance with parity, individual states are better able to monitor compliance by requiring reporting by insurance companies. This system mirrors enforcement of other federally mandated health programs like HIPAA.