Fed probes violations of mental health equity law
Federal government has notified 30 group health plans that do not cover behavioral health services and may violate mental health parity law.
One Report The Labor Department’s announcement on Tuesday did not name specific companies, but gave examples of violations, including claims from a “large service provider” managing hundreds of self-funded programs, excluding treatments for autism. Some plans fail to cover medication-assisted treatment, which addiction experts see as the “gold standard” for treating opioid use disorder.
In all, the Department of Labor and the Centers for Medicare and Medicaid Services issued “preliminary decision” letters to 30 programs and found 48 mental health services covered with more stringent limitations or exclusions than comparable medical or surgical services, in violation of a 2008 Congressional Passed Mental Health Equity Act.
The department will not release the names of the insurance companies that violated the law until a final decision is made. The violations will be made public in the agency’s report to Congress next year.
“The report’s findings clearly show that health plans and insurers are failing to provide equal access to mental health and substance use disorder benefits, which are needed more than ever,” Labor Secretary Marty Walsh said.
Advocates and experts have long suspected the plan was not exactly affirmative action, but until last year the government had limited powers to enforce affirmative action.
One terms Inclusion in the 2020 Government Funding Act requires group health plans to conduct an analysis of their so-called non-quantitative treatment limits to ensure their exclusions or treatment limits comply with the law of parity. These reports must be provided to the government upon request.
The Labor Department requested reports from 156 plans and issuers between Feb. 10 and Oct. 31 last year. Of the reports reviewed so far, 80 were deemed “inadequate” to determine parity.
The Behavioral Health and Wellness Association, the national payer group that administers behavioral health insurance benefits, said it “fully supports the concept of mental health equity,” but accused the Labor Department of not issuing enough guidance and clarity on compliance with the new rules.
“Clear, detailed guidance is needed for NQTL analysis to ensure better compliance with this landmark law,” the group said in a Tuesday release.
David Lloyd, senior policy adviser at the Kennedy Forum, which advocates for better access to behavioral health care, believes insurers have been making excuses for years to avoid full compliance with the Affordable Law and recommends analyzing treatment limits before asking for it. 2020 Congress. He noted that the basic requirements regarding treatment restrictions have not changed since 2014.
“Sometimes plans tell us, or you hear them say ‘We’re still working out how to comply.’ That’s obviously not an excuse anymore, if it ever was,” he said.
“They should be aware of what the law requires, especially for some areas where violations are found.” If they haven’t already, plans should start sorting out their reports, he said.
A final decision on the violations has yet to be made and other reports are still under review, but the Labor Department said early reviews showed some insurers were not complying with the parity law.
One of the most common violations is limiting or excluding or covering autism treatment.
Nine insurers were found not to cover the therapy, called applied behavior analysis, a primary treatment for autism given multiple times a week by behavior specialists over months or years.
Four insurers were found to limit or exclude medication-assisted treatment for opioid use disorder and have unlawful preauthorization or precertification requirements for behavioral health services.
In one example provided by the Department of Labor, a large self-funded health plan covering more than 7,600 participants explicitly excluded methadone and naltrexone as treatments for substance use disorders, but not drugs for medical or surgical conditions. similar restrictions.
Four insurers also limited or excluded nutrition counseling for eating disorders, including two large programs that offer these services to people with diabetes.
According to the Labor Department, after contacting the Labor Department, plans agreed to remove two large programs that were excluded, affecting more than 1.2 million members of those programs.
As of Oct. 31, 26 plans and issuers planned to make changes to more than 40 behavioral health treatment restrictions after contacting the department.
If plans do not meet equality laws, then they must notify their enrollees, and the Labor Department will share the findings with the state where the group health plan is located.
But the department also asked Congress to authorize it to impose civil fines for violations “to greatly strengthen the protection of the law.”
“Without the power to impose civil penalties, (the Department of Labor) has limited ability to ensure appropriate corrective action for violations,” the report states.
Congressional leaders aim to pass a package of legislation this year to expand access to mental health care, and improving compliance with equality laws is expected to be part of the discussion.
“Given the right tools, I believe true mental health equity can become a reality in the American healthcare system,” Senate Finance Committee Chairman Ron Wyden (D-Oregon) commented in a release Wednesday to Labor said the ministry’s report.
Wyden’s committee is working on a bipartisan mental health plan, and the Senate Health Committee and the House Ways and Means Committee will also hold hearings on the issue in February.