Call to action: Member survey on Humana rate cuts and access to mental health care

We need your help to support our ongoing parity advocacy efforts

Nov. 14, 2012—Early November saw two key developments in the APA Practice Organization’s (APAPO) ongoing advocacy efforts in collaboration with 11 state psychological associations challenging Humana’s unprecedented rate cuts. The groups assert that the payment cuts violate the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). 

On Nov. 2, the APA Practice Organization and the Illinois Psychological Association sent a letter (PDF, 102KB) to the Illinois Department of Insurance (DOI) providing detailed arguments to counter Humana’s position that the federal parity law does not apply to provider reimbursement. The Illinois DOI had concurred with Humana’s position in response to a letter this spring from APAPO and state psychological associations, but gave the groups an opportunity to provide evidence that the Humana rate cuts have affected access for Illinois mental health patients.

So APAPO and the collaborating state psychological associations are now launching a survey that will gather data on the effect of rate cuts on network participation and subscriber access to care. We are asking members who are or were Humana providers in any state affected by the company's rate cuts to take our quick survey. Information from the survey will be used in our advocacy with the Illinois DOI, other federal and state agencies, and interested legislators.

 

Illinois advocacy and parity arguments

Illinois advocacy began April 4, 2012 when APAPO and the Illinois Psychological Association (IPA) wrote a letter asserting that Humana’s rate cut, which targets only mental health providers, violates the Interim Final Rules (IFR or parity regulations) implementing MHPAEA.

The IFR requires parity in: “Standards for provider admission to participate in a network, including reimbursement rates.”

This provision, which we call Example C in the letter, is one of six examples the IFR cites of non-quantitative treatment limitations (NQTLs) that must be “comparable” to (but not necessarily equal to) limitations for medical/surgical services. (In contrast to quantitative treatment limitations that can be expressed as a numerical limit, such as number of sessions allowed per year or dollar amount of co-pays or deductibles, NQTLs limit care in other ways, such as through pre-authorization requirements and other medical management.)

On Sept. 18, DOI responded, principally by accepting Humana’s argument that the MHPAEA “does not control rates agreed upon between providers and health plans.” The Nov. 2 letter from APAPO and IPA refuted that argument by analyzing the plain language and intent of Example C and other NQTL provisions. The letter questions what purpose Example C serves, if not to cover network provider reimbursement.

The letter also explains that rate cuts could circumvent all other parity protections by making it more difficult for patients to find a mental health care provider – if DOI fails to enforce this parity requirement. The Nov. 2 letter also cites a February 2012 report on parity implementation commissioned by the Department of Health and Human Services that cites as a parity concern low reimbursement to network providers, which impairs patient access to care. 

Advocacy in other states

In May and June of 2012, APAPO learned that Humana’s cuts had spread to eight other states. In July 2012, APAPO and ten state associations wrote to the federal parity regulators about the Humana rate cuts in those states. (IPA did not officially join that letter because its complaint was already before the Illinois DOI.) Now that we have finalized our response to Humana’s arguments in Illinois, we will be working with the other state associations to develop complaint letters to their state insurance commissioners. 

We will continue to provide updates on this priority advocacy effort as they become available.

For more information, contact the Legal & Regulatory Affairs department by email or by phone at (202) 336-5886.