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January 09, 2017 at 09:27 AM
Cigna Corp. and the Blue Cross and Blue Shield Association say the federal government should put new behavioral health parity compliance rules through a formal review period, not package them as an informal batch of advice.
The Employee Benefits Security Administration, the Internal Revenue Service and the U.S. Department of Health and Human Services have tried to put new parity compliance guidelines in a set of answers to frequently asked questions about implementation of the Affordable Care Act.
Related: Feds: ERISA plans must share their decision support tools
Technically, the answer is just an informal batch of advice, not a regulation. The Obama administration “tri agencies” said in their answer, in October, that they want health insurers and health plans to explain their reasoning when they refuse to cover mental health or addiction treatment services.
The Mental Health Parity and Addiction Equity Act of 2008 and federal regulations based on the Affordable Care Act require plans to cover physical health and behavioral health services using the same “quantitative limits,” such as deductibles and office visit frequency limits.
Plans are also supposed to offer parity when it comes to “nonquantitative treatment limits,” or matters such as prescription drug formulary design and standards for letting providers participate in a plan’s network.
Officials also have said that plans should disclose all formulas, standards for evidence, and other instruments used to make behavioral health coverage decisions. They suggested they could develop one, or several, model notices to help plans share information about behavioral health benefits decision processes with the patients.
Officials did ask for comments on their advice.
But David Schwartz, an executive at Cigna’s federal affairs unit, and Slackman, a regulatory policy specialist in the Washington office of the Blue Cross and Blue Shield Association, write in their comment letters that the tri agencies should handle the matter through the formal rulemaking and paperwork creation processes, not rush any new form or forms out in informal guidance.
Confusion warning
Slackman warns against the government creating forms that give a few examples of bad coverage decisions, rather than a complete list.
If the government creates an incomplete form, that could drive up costs by creating “a proliferation of additional disclosures, which in turn would lead to confusion (and higher administrative costs) as to what disclosure is being requested and what must be supplied in response,” he says.
