MHAMD

Mental Health Association of Maryland

Just Released FAQ on the Federal Parity Law

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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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Maryland Parity Project is Currently Filing Complaints

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The Maryland Parity Project’s complaint investigation process is underway!  To date, we have filed 4 complaints on behalf of providers and consumers – all are in varying stages of investigation. Of these complaints, 3 were of perceived violations of the nonquantitative treatment limit regulations, mainly prior authorization processes and requirements that were more restrictive than those required for medical or surgical care. The most recent complaint addressed a small group insurer who had implemented a limit on the number of visits for outpatient mental health care.

All 4 of the complaints were filed with the Maryland insurance Administration and 3 of them were cross filed with the U.S. Department of Labor. Investigations were initiated and are still pending.

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A Push for Clearer Regulations, Meetings with the Maryland Congressional Delegation

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The Maryland Parity Project, Maryland Psychiatric Society, Maryland Psychological Association, Mental Health Association of Maryland, NAMI Maryland, and the University of Maryland School of Law Drug Policy Clinic recently met with staff of the entire Maryland Congressional Delegation and Congressman Chris Van Hollen, who found the time to spend 30 minutes with us despite his busy schedule, to press for final parity regulations governing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

What We Asked:

The Interim Final Parity Regulations which went into effect July of 2010 left many critical questions unanswered and the Department of Health and Human Services (DHHS) has yet to issue final regulations to clarify these and ensure the full intent of the parity law is realized. The National Parity Implementation Coalition has identified four critical issues to ensure parity is enforced.   For more information see the Implementation of Federal Parity in Maryland briefing memo used in our meetings.

The Follow-up:

Several staffers promised to contact DHHS staff to push for promulgation of the final regulations. All promised to stay engaged, and MPP will keep them informed of developments until the final regulations are issued.

What You Can Do:

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.  All of the legislative staff asked for real life examples to help them understand why these final regulations are so important.  Click here for a Sample Letter to Legislators you can personalize.

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Top Five Reasons You Should File a Parity Complaint

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1. There is someone to help you. Staff of the Maryland Parity Project is available to help you with the paperwork, the research and the phone calls. We understand most people don’t have time to deal with these tedious details which is why we will do most of the leg work.
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2. Complaints demonstrate the scope of the problem. The regulators have asked to see specific cases where violations have occurred or where the regulations may be unclear or ambivalent. We have a small window of opportunity before the final regulations are written and published. If we want our voices heard, we must bring the regulator’s attention to the consistent problems.

 3. Appeals and complaints are often found in favor of the consumer. A 2010 report by the Maryland Insurance Administration showed that 60% of complaints of adverse decisions (denial for reasons other than lack of covered benefit) are either reversed by the insurer or overturned by the MIA.

 4. You can help change the system so someone else does not have to go through the same difficult process. We understand the appeals process is tedious and time consuming, but if you take time to work with us and file an appeal, you be may be successful in getting reimbursement for treatment. In addition, the insurer may decide to change a questionable policy or may be forced to do so by the MIA or DOL. Your efforts may save others the time in filing an appeal and may give them access to treatment that might otherwise be denied. Our goal is to change systems to benefit the individual.

 5. Without complaints the insurers have no reason to change their policies. There are areas of regulations where insurers and those of us in the mental health community disagree.  Insurers believe they are in compliance with the law, and until we can prove otherwise, they will continue their business as usual. We must force them to comply with the intent of the law, closing loopholes in the process.

10 Things You Should Know About the Mental Health Parity Law

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1. Current regulations went into effect in January of 2010.
The Wellstone and Domenici Mental Health Parity and Addiction Equity Act was passed in 2008, but Interim Final Regulations were released in 2010. All insurance plans that are not specifically exempted from the law must now be in compliance.

2. The law applies to ALL large employers, including self-funded.

It also applies to state government plans and federal employee plans. It does not apply to small employers of 50 employees or less. Medicare and US Department of Defense and TriCare plans are also NOT covered under this law. Learn More

3. Specific regulations for Medicaid have not been created, but Medicaid must be compliant with current regulations.
The Centers for Medicare Medicaid Services are currently working on Medicaid specific regulations, which should be released in 2011. Until that time any managed care organization that offers both medical and mental health or addiction benefits must adhere to current regulations. Learn More

4. The law DOES NOT force an insurer to offer mental health or addiction benefits.
This law does not require plans to offer mental health or addiction benefits, but all covered plans that offer ANY mental health or addiction benefits must offer those benefits on-par with medical surgical benefits. Learn More

5. If your plan has out-of- network medical benefits and ANY mental health or addiction benefits, they must also offer out-of-network mental health and addiction benefits.
The regulations created 6 classifications of benefits that are used to compare the levels of benefits. These classifications cover both in-network and out-of-network services. Learn More

6. There is a penalty for non-compliance with the law. Internal Revenue Service is empowered to assess tax penalty to insurers who are not compliant.
Three federal agencies have policing power over health insurance plans: Department of Health and Human Services, Department of Labor, and the Internal Revenue Service. Complaints by consumers and providers are investigated and the IRS can levy tax penalties each day that an insurer is not in compliance.

7. The regulations state that your financial requirements and treatment limitations can be no more restrictive for mental health or addictions than for your other health benefits.
This means you cannot be forced to pay a higher co-pay or have a limit on your number of visits that is less than for your other health visits. It also means that treatment limitations such as requiring prior authorization for visits cannot be more restrictive for mental health or addiction treatment. Learn More

8. Your insurer must supply you with written reason for denial of treatment and explanation of how they determined whether or not the treatment was medically necessary.
This information must be supplied upon request and free of charge. Learn More

9. You may file a complaint under this law with the Maryland Insurance Administration and the US Department of Labor.
The Maryland Insurance Administration will handle complaints for fully insured plans. The US Department of Labor will handle complaints for government plans, self-funded plans, and Medicaid. Learn More

10. People are waiting to help you file appeals and complaints to make sure you get the treatment you deserve.
The law is only as effective as we make it. We have the right to appeal denials and lodge complaints, but if we don’t use that right it is meaningless. If you feel your insurer may be in violation, contact Adrienne Ellis, Director, Maryland Parity Project, at aellis@mhamd.org or 410-235-1178, ext. 206. Learn More

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