Saying that there is too much confusion between the requirements of the new health reform law and the not-yet-final mental health parity law regulations, a group of mental health behavioral care organizations has sued the federal government to delay the implementation of the rules.
Meanwhile, the American Psychiatric Association is pressing the government to move forward, saying that some health plans are imposing cost control techniques that subvert the parity law's intent and are restricting patient access to care.
The litigation was filed by Magellan Health Services, Beacon Health Strategies, and ValueOptions. The companies supported the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, but are not satisfied with the interim final rules issued in February by the Department of Health and Human Services, the Department of the Treasury, and the Department of Labor, saamela Greenberg, president and CEO of the Association for Behavioral Health and Wellness, said in an interview.
The association is not involved in the suit, she said, but would prefer a 1-year delay in the issuance of the final rules to give mental health managers time to comply.
The law went into effect Jan. 1. Most insurers and employer-based plans began complying with the intent of the law at that time, but awaited the exact details that would be spelled out in the regulations. With the issuance of the interim final rules, all plans must comply for plan years that start July 1.
Insurers and managed behavioral companies object to the “nonquantitative treatment limits” spelled out in the interim final rules, Kris Haltmeyer, executive director of policy for the BlueCross BlueShield Association, said in an interview. The Blues did not join the suit, but is also seeking a delay until July 2011, Mr. Haltmeyer said.
According to the rules, viewable at www.regulations.gov
The Blues would argue that the parity legislation never explicitly discussed whether plans could use traditional behavioral benefit management techniques, such as prior authorization or formulary tiers, so the rules go beyond the intent of the legislation, Mr. Haltmeyer said. Without those tools, plans might have to clamp down further on all health care services to achieve true parity in benefits and cost control, he said.
Psychiatrists, however, say they increasingly are being burdened with bureaucratic requests from insurers that seem designed “to drive physicians out of the network and to block patient access,” Jennifer Tassler, deputy director of regulatory affairs for the APA, said in an interview.
Plan administrators have the legal right to manage the benefit, but it's being overzealously and unfairly applied, she said. The APA has received reports that physicians are being asked in some cases to get prior authorization before every patient visit or to submit treatment plans after every few visits.
In comments to the government, the APA expressed its support for the restrictions on nonquantitative limitations and a single deductible. The organization is concerned, however, that the rules did not appear to apply to Medicaid-managed care plans and urged the government to issue regulations to cover those plans.
Overall, though, the interim final rules “went a long way to clear up what the law intended and covered,” Ms. Tassler said.
No one knows when final rules might be issued. The government also issues interim final rules that stand, she said. The insurers are aware of that possibility, which is why they are seeking a delay in implementation, Mr. Haltmeyer said.
Mental Health Parity's Evolution
September 1996 The Mental Health Parity Act establishes parity for lifetime and annual dollar limits.
October 2008 The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) is enacted, guaranteeing full parity with medical and surgical benefits and out-of-pocket costs.
April 2009 The federal government seeks comments on how to implement MHPAEA.
October 2009 MHPAEA goes into effect for the plan year starting January 2010.
February 2010 Interim final rules are published.
May 2010 The comment period closes for the interim final rules.
July 2010 The rules apply to all plans.