The Biden administration has proposed tightening up enforcement of the federal laws that govern requiring mental health parity, a group of statutes that include the watershed Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and the Consolidated Appropriations Act of 2021, which requires health plans to perform analyses that compare “nonquantitative treatment limits” (NQTLs) on mental and behavioral health benefits with those for medical and surgical services.
NQTLs include rules governing prior authorization, provider reimbursement rates and provider networks. Under the mental health parity laws, the NQTLs for mental and behavioral services are supposed to be no more restrictive than they are medical and surgical services.
If the administration’s new rules are finalized, they would require health plans to supply more detail in their NQTL comparative analyses. The analyses would have to include, for example, new information comparing claims denials for mental and behavioral health services to denials for medical and surgical services.
Health plans might also be facing new requirements to provide data that will allow regulators to compare their networks of mental and behavioral health providers to their networks of medical and surgical providers. One of the main gaps in mental health parity with respect to health insurance has been the shortage of in-network providers.
A July 2023 enforcement report listed several examples of NQTL shortcomings flagged by federal regulators:
Excluding coverage of residential treatment for mental health and substance use disorders when residential treatment for medical and surgical treatment was covered
Using employee assistance programs (EAPs) as gatekeepers to services for mental health and substance use disorder services when plan members didn’t have go through an EAP to use medical or surgical benefits
Excluding methadone as a treatment for opioid use disorder but covering it for medical and surgical conditions
Not covering inpatient substance use disorder treatment unless the member completes the entire course of treatment when no such requirement exists for medical or surgical treatment.
Bridging the Diversity Gap in Rare Disease Clinical Trials with Harsha Rajasimha of IndoUSrare
November 8th 2023Briana Contreras, an editor with Managed Healthcare Executive, spoke with Harsha Rajasimha, MD, founder and executive chairman of IndoUSrare, in this month's episode of Tuning in to the C-Suite podcast. The conversation was about how the disparity in diversity and ethnicity in rare disease clinical trials in the U.S. has led to gaps in understanding diseases and conditions, jeopardizing universal health, and increasing the economic burden of healthcare.
Listen
Managing Editor of Managed Healthcare Executive, Peter Wehrwein, had a discussion with William Shrank, M.D., a venture partner with Andreessen Horowitz, a venture capital firm in Menlo Park, California, about how artificial intelligence's role is improving healthcare, where we are today with value-based care and the ongoing efforts of reducing waste in the healthcare space for this episode of the "What's on Your Mind" podcast series.
Listen
35th World AIDS Day Marks 20 Years of PEPFAR: Challenges and Strategies to Combat HIV/AIDS
November 29th 2023PEPFAR, having invested $100 billion and saved 25 million lives in the global fight against HIV/AIDS, faces Congressional hurdles in its reauthorization due to abortion debates. Despite widespread support and no evidence of abortion-related activities, the legislative process is at a standstill. Members of PEPFAR and authors of a recent editorial stress the significance of PEPFAR and advocate for integrating behavioral and social science into healthcare programs to achieve UNAIDS targets and address barriers in HIV/AIDS testing and treatment.
Read More