Rep. Joseph Kennedy III (D-Mass.) says a health plan gave his own legislative director the runaround last week when she asked for documents related to behavioral health parity.
The Obama administration has ruled that patients have a right, under the federal Mental Health Parity and Addiction Equity Act of 2008, to see documents describing how a plan decides whether a particular mental health care treatment, substance abuse treatment or other health care treatment is medically necessary.
The aide “spent over two unsuccessful hours on the phone with her insurance company last week, trying to get the medical necessity documents she’s entitled to by law, and has still yet to receive,” Kennedy said today during a House Energy & Commerce health subcommittee hearing on federal mental health parity laws and regulations.
Committee leaders agreed to hold the hearing in June, after Kennedy, who is President John F. Kennedy’s great-nephew, complained about what he believes to be a widespread lack of enforcement of MHPAEA requirements.
Kennedy has introduced H.R. 4276, the Behavioral Health Coverage Transparency Act bill. The bill, which has 11 co-sponsors, could require health insurers to disclose mental health care coverage denial rates and reasons for denials. The bill would also require the government to set up a new parity compliance audit program.
Officials at the U.S. Department of Labor have said they are already using existing MHPAEA authority to step up parity audit efforts.
Matt Selig, a witness from Health Law Advocates, a Boston-based firm that provides legal services for poor people, said his organization handles about 70 behavioral health benefits denial cases each year.
Clients seem to have the most trouble with getting approvals for residential treatment for serious disorders, applied behavioral analysis services for autism spectrum disorders, and access to two or more outpatient psychotherapy sessions per week, Selig testified.
Pamela Greenberg. (House hearing screen capture)
Industry witnesses say the government should be more transparent
Pamela Greenberg, the president of the Washington, D.C.-based Association for Behavioral Health and Wellness, a group for plans that cover mental health care and substance abuse treatment, said member plans already go many parity audits at both the state and the federal level.
The parity requirements are complicated, and one member company has told the association it has had to perform parity analysis for more than 100 plans for a single employer customer, Greenberg testified.
The plans have been struggling to get the information they need to know how to comply with the parity requirements, Greenberg said.
One problem is that agencies have imposed tough disclosure requirements, but the current disclosure requirements lead to the creation of documents that are impossible for most consumers to understand, Greenberg said.
“There needs to be a more concise option,” Greenberg said.
Dr. Michael Trangle, a psychiatrist who serves as a senior medical director at HealthPartners’ Regions Hospital in St. Louis Park, Minnesota, works for a company that provides mental health services and also runs its own insurance companies.
One major problem patients, providers and plans face is a lack of widely accepted outcomes measures, or statistics that show what types of care actually work, and which providers and behavioral health facilities are getting good results, Trangle said.
“Most behavioral health quality measures are clinical process of care measures,” Trangle said. “Only a few which tend to be in the outpatient realm, are outcome measures.”
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