APAPO continues mental health parity implementation advocacy

New comment letter to the Department of Labor addresses enforcement, transparency, reimbursement and other issues.

In response to a request from the U.S. Department of Labor, the APA Practice Organization (APAPO) submitted a comment letter on Jan. 8, 2014, (PDF, 133KB) addressing concerns related to implementation of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). 

The Department of Labor invited comments about what additional steps could be taken to ensure compliance with MHPAEA through health plan transparency, including what other disclosure requirements would provide more transparency to participants and providers. APAPO addressed this issue along with several others, building on our 2010 comment letter about implementation of the interim final rule (IFR) about mental health parity and our April 2013 letter on how to make the Final Rule more enforceable. 

The Jan. 8 letter addressed five areas of importance for psychologists and access to psychological services: 

  • Enforcement. The letter to the Department of Labor details the numerous letters APAPO (in collaboration with state psychological associations) has sent to federal and state enforcement agencies in response to rate cuts by Blue Cross Blue Shield of Florida and Humana. To date, no federal or state agency has concluded an investigation or taken enforcement action. The lack of enforcement has emboldened Humana to continue to cut rates. APAPO suggests having plans and insurers provide basic information in response to significant complaints from major parity stakeholders if parity enforcement agencies cannot act promptly, and setting time limits for state insurance commissioners to review complaints before the Department of Health and Human Services’ (HHS) can take action, and setting time frames for the federal agencies to conclude their investigations. 
  • Reimbursement disparities. The letter cites data that rate cuts targeting psychologists decimate networks and adversely affect patient care. APAPO recommends that the departments issue more detailed examples of how they intend to enforce parity in provider reimbursement related to limits on the scope or duration of benefits for treatment. 
  • Transparency of medical necessity criteria. APAPO and several state psychological associations have experienced problems with certain BCBS companies limiting patient and provider access to their medical necessity criteria. The letter argues that the clear mandate of the parity law prevents companies from limiting access only to current subscribers and providers, or only to those situations where care has been denied. The letter also argues that the parity law’s mandate does not allow companies to withhold proprietary criteria that an insurer may have purchased from an outside vendor. 
  • Medical necessity and long-term mental health patients. Some insurers use medical necessity determinations to limit the care of patients with long-term mental health needs in ways that APAPO believes are not applied to the care of patients with chronic medical conditions. APAPO requests that the federal departments responsible for parity enforcement issue guidance on how they would evaluate disparities in medical necessity determinations for patients with chronic mental health needs.
  • Medicaid/CHIP. With the implementation of the Patient Protection and Affordable Care Act, the Medicaid population is growing significantly and more beneficiaries will be in need of mental health treatment. APAPO asks the Centers for Medicare and Medicaid Services (CMS) to issue regulations applying mental health parity to Medicaid and the Children’s Health Insurance Plan (CHIP) as soon as possible.

APAPO will continue to track issues related to mental health parity implementation and will follow up with enforcement agencies as needed. If one of your patients has suffered a significant denial of mental health care that may violate the Mental Health Parity and Addiction Equality Act, the Affordable Care Act or related state parity laws, please contact the Office of Legal and Regulatory Affairs by email or by phone at (202) 336-5886.