APAPO comment letter expresses concern that some state plans do not comply with MHPAEA.

On Sept. 30, the APA Practice Organization (APAPO) submitted comments to the Centers for Medicare and Medicaid Services (CMS) and the Center for Consumer Information & Insurance Oversight (CCIIO) in response to the request for comments on the states’ submissions for the 2017 Essential Health Benefits (EHB) benchmark plans.

APAPO is concerned that some states’ proposed benchmark plans for 2017 do not comply with the requirements of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). 

Under the Affordable Care Act, all health plans offered in the individual and small group markets as of February 2014, both inside and outside the health insurance exchanges, must offer a core package of 10 essential health benefits, one of which is mental health and substance use services. 

To implement essential health benefits, states were asked to select a "benchmark plan" to serve as a reference point. For plan years 2014-2016, benchmark plans were based on a plan sold in the state in 2012, meaning many did not comply with the Feb. 25, 2013, Department of Health and Human Services (HHS) final rule on essential health benefits, which determined that the federal parity law applies to essential health benefits. For plan year 2017 and beyond, the state EHB benchmark plan is based on a plan sold in 2014. Beginning in 2017, EHB plans must comply with federal parity requirements.

“APAPO has identified some concerns that certain states’ proposed plans do not cover mental health services appropriately in compliance with MHPAEA,” says APA Executive Director for Professional Practice Katherine C. Nordal, PhD. “We believe it is critically important for patients that proposed benchmark plans are in compliance with the Affordable Care Act and the federal parity law.” 

Two different categories of federal parity violations were also noted in the APAPO review of proposed benchmark plans:

  • Quantitative Treatment Limitations are coverage restrictions that limit benefits based on the frequency of treatment, number of visits, days of coverage or other similar limits in scope or duration. Such treatment limitations conflict with federal parity requirements. APAPO has concerns about quantitative treatment limitations in the proposed state EHB plans for Alabama, Alaska, Florida, Mississippi and South Carolina. 
  • Non-quantitative Treatment Limitations (NQTLs) are coverage restrictions that limit the scope or duration of benefits for treatment. If a plan automatically excludes from coverage certain types of treatments or treatment settings for mental health benefits but does not automatically exclude similar types of treatments or settings for medical/surgical benefits, the plan may be in violation of the federal parity law. APAPO has concerns about NQTLs in Texas, Arizona, Arkansas, Delaware, Idaho and Michigan.
  • Other coverage concerns regarding vaguely defined limitations or exclusions are specifically addressed for the states of Nevada, North Dakota and South Dakota.

Read the Practice Organization’s comment letter to CMS and CCIIO (PDF, 165KB).

APAPO will continue to keep members informed about related developments and other advocacy efforts involving the 2017 Essential Health Benefits (EHB) benchmark plans. State compliance with the Affordable Care Act and MHPAEA remains a top legislative priority of the APA Practice Organization.