At the urging of MHAMD and others, the Maryland General Assembly and the Maryland Insurance Administration have taken important steps in recent years to ensure the proper implementation of the federal Mental Health Parity and Addiction Equity Act. Unfortunately, according to the findings in a groundbreaking new national report, there is still much work to be done. This is the message MHAMD shared at a briefing on January 30 for members of a key legislative committee.
According to an independent report by the Milliman Group, Maryland is among the worst states for access to affordable in-network behavioral health (mental health and substance use disorder) services. The national actuarial firm analyzed three years of insurer claims data from 2013 to 2015, covering approximately 42 million Americans in all 50 states and Washington, D.C.
The data demonstrates that insurers in Maryland are much more likely to provide in-network care for physical health services compared to mental health and substance use treatment services. This limits access to care and results in higher out-of-pocket costs that can make treatment unaffordable, even for those with insurance.
Among the key findings:
- In 2015, Maryland consumers were nearly 1,000 percent more likely to go out-of-network for behavioral health office visits compared to primary care visits. That’s nearly twice the national average, and third worst in the nation.
- Marylanders were 700 percent more likely in 2015 to utilize out-of-network facilities for inpatient behavioral health care compared to those accessing inpatient treatment for physical health care.
The study also uncovered a troubling disparity in reimbursement rates for the professionals treating individuals with behavioral health needs as compared to those providers delivering physical health treatment. In 2015, mental health and substance use treatment providers were paid over 27 percent less than other providers for the very same office visits billed using identical or similar payment codes. This disincentives medical professionals from entering the behavioral health field, exacerbating an existing workforce shortage and further limiting access to care for Marylanders in need.
MHAMD is proud of the work we’ve done in recent years to implement the critically important federal parity law, and we are appreciative of our ongoing partnerships with members of the Maryland General Assembly, the Maryland Insurance Administration and stakeholders in the behavioral health community. Together, we have passed laws and created regulations designed to improve treatment options and availability for individuals with mental health and substance use disorders. We still have a long way to go, but MHAMD will keep working to ensure Marylanders with behavioral health needs have access to treatment when and where needed.
Last month, the US District Court for the Northern District of California certified a nationwide ERISA class action suit against United Behavioral Health (UBH). The lawsuit alleges that UBH is in violation of ERISA because they systemically deny coverage for mental health treatment. ERISA requires that medical necessity be evaluated according to generally accepted standards of care. The suit alleges that UBH develops and applies medical necessity criteria that are outside the generally accepted standards of care for outpatient, intensive outpatient, and residential treatment for mental illness and substance use disorders. The criteria for mental health care is far more stringent than for medical care as it requires the presence of acute symptoms allowing them to deny coverage for treatment needed for individuals who are experiencing chronic and persistent mental illness.
The certification as a class action is important because it means that individual UBH consumers will not need to file separate lawsuits, which is what UBH argued should happen. While this class action was certified in California, it was certified as a nationwide case. The plaintiffs in the case represent all harmed UBH customers, so if the case is decided in favor of the plaintiffs then all harmed UBH consumers across the country may be entitled to monetary relief from UBH.
The Maryland Parity Project was proud to host three presenters from the US DOL Employee Benefit Security Administration on June 11th. The presenters gave a comprehensive overview of the current federal mental health parity regulations, using concrete examples to make the regulations understandable.
Presenters did their best to answer questions about insurers compliance with non quantitative treatment limitations (NQTL), current investigations at DOL, and difficulties getting insurers to disclose their medical management procedures and criteria. Presenters were also open to taking comments back to others working on final regulations with the possibility of future release of more subregulatory guidance in the form of FAQs. Participants offered comments on varied issues:
- difficulty getting insurers to disclose information
- the possibility of unintended loopholes in the NQTL regulations
- the feasibility of requiring insurers to perform parity analyses of their benefit design and submit them to DOL rather than wait to be prompted by a complaint
- difficulty for insurers to comply with NQTL regulations without some quantitative measures to use for analysis purposes
Of course, presenters were unable to give participants any idea of when the final rule would be released or specifics of current investigations underway or outcomes of past investigations. Overall this was a great event that set the stage for the upcoming DC Metro Congressional Forum and established a dialogue where stakeholders are able to forward other comments, questions or examples of issues not addressed by the current regulations. If you have comments or questions, please Contact Us.
Press Release of the Los Angeles Law Firm of Cohen Mckeon, May 21, 2012
A class-action lawsuit was filed against United Healthcare Insurance Company, US Behavioral Plan, and California United Behavioral Health, which contracts with employers such as the University of California to provide mental health services to policyholders.
The class-action suit alleges that these companies, which are part of United Healthcare Insurance Company, have violated the California Mental Health Parity Act, which requires insurers to provide treatment for mental-health diagnoses according to “the same terms and conditions” applied to medical conditions. Specifically, the defendants are accused of denying and improperly limiting coverage by conducting concurrent and prospective reviews of routine outpatient mental health treatments when no such reviews are conducted for routine outpatient treatments for other medical conditions. Defendants are also accused of violating the Unruh Act, by discriminating against a class of persons with mental disabilities and psychiatric conditions; violating California’s law prohibiting unfair competition, breaching the terms of its own insurance contract with policyholders, and the implied covenant of good faith and fair dealing.
The law suit was filed in Santa Barbara Superior Court on behalf of the plaintiff, who works in Santa Barbara. Her mental health coverage was improperly reduced. She was having four weekly outpatient psychotherapy sessions, but in September, 2011 she was informed that she would limited to one weekly session for one month. Plaintiff is represented by the Los Angeles-based class-action trial lawyers of Cohen McKeon LLP, and Meiram Bendat, founder of the mental health insurance-advocacy service, Psych-Appeal.
“This is an important case because it addresses an issue that impacts a wide range of people who are covered by health insurance” said lead attorney, Michael L. Cohen. “For too long, people who suffer from severe mental health issues have not received health insurance coverage on the same terms as conditions that are applied to other conditions.”
Recently, 15 insurance companies were fined a combined $2.7 million dollars for failure to comply with Timothy’s Law, New York’s mental health parity law. Read Rep Tonkos Response
Regence Blue Cross Blue Shield of Oregon has slashed mental health benefits and raised deductibles for medical care.
Advocates “walk a mile” to press for a state parity law, advocate for an end to stigma-perpetuating language, and urge for continuance of funding for meaningful employment opportunities. Michigan is one of only 8 states without a mental health parity law.
The US Department of Labor released new FAQ on Implementation of the Mental Health Parity and Addiction Equity Act of 2008 on May 9, 2012. The FAQ are fairly general and contain little new or not previously released information. A few noteworthy items include-
- Q6 asks if nonquantitative treatment limits (NQTL) are analyzed as quantitative treatment limits, mathematically. The response is very clear that there are no mathematical rules for analyzing NQTLs, but the response does not specify how the NQTLs are analyzed.
- The response to Q8 clarifies that retiree-only plans (such as the Maryland State Employee Retiree Plan) are NOT subject to federal parity regulations. The response also states that if a non-federal government plan wishes to opt-out it must take certain administrative steps, such as sending a notice to members.
- Also of note is USDOL states they are committed to working worth stakeholders including state regulators, plan issuers, providers, and beneficiaries to promote compliance with MHPAEA.
In recently released press release, Thomson Reuters says the findings from two separate studies done by Thomson Reuters researchers in conjunction with SAMHSA, show that increased behavioral health coverage is unlikely to be costly to employers. The primary reasoning being the low utilization and small amount of spending for behavioral health. The studies showed that behavioral health spending accounted for only 5.9% of an employer’s total healthcare spending from 2001-2009.
We have a long way to go to remove stigmas and enable people to fully access behavioral health treatment, but convincing employers and insurers that providing coverage for such necessary care is not only appropriate but also affordable is a small step down the right road.
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Please Contact Us if you have questions or need help with a potential parity complaint.
Parity Champions Representatives Kennedy and Ramstad persist in the parity battle. Both were sponsors of the Mental Health Parity and Addiction Equity Act and were instrumental in its passage. At a lunch on March 14th at the National Press Club, Kennedy and Ramstad pledged their commitment to stay involved in the fight for final regulations to ensure the bill is implemented appropriately. You can watch video from the Luncheon presented by CSpan.
The luncheon was the kickoff to planned field hearings that will take place around the country this year to put a face to the discrimination still occurring. Kennedy and Ramstad have urged advocates, consumers, and providers to get engaged for the final push to implement the law. The field hearings are an effort to pressure HHS and DOL to issue final regulations for this landmark law. Tentative dates for the field hearings include:
April 26- Kalamazoo, MI
May 22- Los Angeles/San Diego, CA
June 26- DC Metro
July 17- Minneapolis, MN
We will have more information on the field hearings as they progress, including the June 26th hearing in this region. If you are interested in participating in the June 26th hearing, please Contact Us. Stay up to date on this and other parity issues by Sign Up for Alerts.
In November, the U. S. Department of Labor launched a new online form for all health insurance questions and complaints. The form isn’t specific to Mental Health Parity and Addiction Equity Act complaints or questions, but can be used for parity questions and complaints. Consumers and providers will need to input specific information about their situation and upload any relevant documents if they are using the form to file a complaint.
In their news release, US DOL has said that people using the form should expect an initial response within three days, either getting an answer to the question submitted or a referral to an Employee Benefit Security Administration benefit advisor. If this timeframe holds true, it would be a big improvement over the current system. We haven’t used the new form yet, but we are anxious to test it and the promised timeline.
If you, a patient, or someone you know are having difficulty dealing with a health insurer, please Contact Us.
The US Department of Labor (USDOL) released FAQS About Affordable Care Act Implementation Part VII and Mental Health Parity Implementation on November 17, 2011. While these FAQs do not address all of the issues identified and aren’t everything advocates asked for, they do offer more clarity on Non Quantitative Treatment Limitations, (NQTL) specifically utilization review requirements.
In Question 3 and Question 5 US DOL uses examples to clarify that a plan may not have more stringent prior authorization processes for mental health/substance use disorder treatment than they do for medical/surgical treatment. This clarification and the example used should help investigators make determinations on the complaints MPP filed regarding prior authorization policies. We will also be able to point to these FAQs in future NQTL complaints.
We are pleased that MHPAEA continues to be of importance to US DOL and we are glad to have this subregulatory guidance, but we can’t be sure plans are in full compliance with the law until final regulations have been promulgated. We continue to urge regulators (link to cong. Del blog post) to finalize these regulations.
Call or write your legislator to ask that he or she contact DHHS to push for final regulations for the Mental Health Parity and Addiction Equity Act of 2008. Be sure to include a personal story about why this is important to you or and/or share any difficulties you are having in getting mental health or addiction treatment for yourself or a client. Here is a Sample Letter to Legislators you can personalize.
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