Behavioral Health

The Biden administration on Sept. 9 finalized a sweeping set of regulations that aim to ensure health plans are covering behavioral health treatment as comprehensively as they cover medical care. The move was met by rapid criticism from a coalition of trade groups representing health insurers and large employers, which argued the new regulations “will not address the inadequate supply of mental health providers.”

But other groups, such as a mental health advocacy organization tied to the Kennedy family, welcomed the rules as a necessary step forward to ensure compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA). And one health policy expert tells AIS Health, a division of MMIT, that there are reasons to be skeptical of some criticisms lobbed at the new regulations by plan sponsors and insurers.

CareFirst BlueCross BlueShield, one of the largest insurers in the mid-Atlantic region, recently announced its involvement in a program for early stage technology companies looking to develop artificial intelligence (AI) products for the health care sector. A CareFirst executive tells AIS Health that the payer hopes to learn more about what is happening in the AI space for potential use within the company. One expert, however, says insurers for the most part are still contemplating how to implement AI in their workflows while also being cognizant of its potential flaws.

CareFirst is partnering with Johns Hopkins University for the TechStars AI Health accelerator that will take place in March 2025 in Baltimore. TechStars is a company that invests in and provides guidance and money to startup companies in several industries. The firm hosts numerous so-called accelerators, which are months-long programs where founders of young companies meet with experienced industry leaders and investors. TechStars invests $120,000 in the companies it chooses for the accelerators in exchange for a 6% to 9% equity stake. Most accelerators receive hundreds of applicants, of which TechStars usually selects 20 or fewer to participate.

Children and adolescents were much more likely to access necessary mental and behavioral health (MBH) services if they lived in states that mandate insurance coverage for mental health care, according to a recent study published in JAMA Network Open.

The study is based on responses from almost 30,000 caregivers of kids and adolescents ages 6 to 17 years with mental and behavioral health conditions in the National Survey of Children’s Health and State Mental Health Insurance Laws Dataset (SMHILD) from 2016 to 2019. The comprehensiveness of state MBH insurance laws was defined by the SMHILD score and categorized as 0 to 2, 3, 4, and 5 to 7.

Most state Medicaid programs require managed care plans to cover some common treatments and medications for substance use disorder (SUD), according to a study published this month in Health Affairs. However, Lauren A. Peterson, one of the study’s authors, tells AIS Health, a division of MMIT, it is “concerning” that only half of the states that contract with managed care plans require coverage of all treatments and services recommended by the American Society of Addiction Medicine (ASAM).

While Peterson, a Ph.D. candidate at the University of Chicago, acknowledges that “states are really making a commitment to cover [SUD treatments],” she says she and her co-authors agree with ASAM that all SUD treatments should be available.

Ever since racial justice activism swept the country in 2020 following the death of George Floyd, racial disparities in health care have become a focus in the health care industry. Perhaps even more than in recent years, health equity was one of the most-discussed topics at the AHIP 2024 conference in Las Vegas.

But presenters at the conference made clear — as have their counterparts at other industry meetups — that health equity is a work in progress. Awareness of racial health disparities may be at an all-time high, but tangible progress is as elusive as ever.

CDPHP, a not-for-profit managed care organization serving Medicare Advantage members primarily in Upstate New York and the Hudson Valley, is one of several provider-led insurers that carried a strong growth trajectory from the Medicare Annual Election Period (AEP) through the Open Enrollment Period (OEP) in the first quarter of 2024, according to a recent AIS Health analysis.

The Albany-based insurer added more than 5,000 MA members during the AEP and another 5,400 between February and May, for overall growth of 20% since October, per AIS’s Directory of Health Plans. According to CDPHP’s senior vice president and chief growth officer, Nicholas Kraft, the plan nabbed 66% of new enrollment in its market and is now the third-fastest growing MA plan in the U.S. CDPHP was also ranked No. 1 in member satisfaction among commercial insurers in New York State by J.D. Power & Co.

The ERISA Industry Committee (ERIC), a benefits trade group for large employers, launched an ad campaign attacking the Biden administration’s mental health parity policies — a notable escalation in plan sponsors’ intensifying opposition to the administration’s approach to mental health care access, which could ultimately lead to litigation.

In a press release, ERIC said it hopes to influence upcoming mental health parity regulation, noting that “departments of President Biden’s administration, including the U.S. Departments of Health and Human Services (HHS), Labor (DOL) and the Treasury are finalizing proposed rule changes regarding mental health and substance use disorder parity.” The expected rule would be a finalized version of a regulation released in September 2023, which calls for much stricter network adequacy standards than were required in previous parity rulemaking.

Medicaid managed care organizations’ compliance with mental health parity laws and regulations varies widely by state, according to an HHS Office of Inspector General (OIG) report and industry experts. The wide range and, in some cases, widespread noncompliance with parity laws will be the subject of possible new regulations in Medicaid managed care.

The OIG report is an early sign that the Biden administration intends to train its sights on state Medicaid agencies and their MCOs’ mental health parity compliance, which would follow several years of heightened scrutiny on commercial plans’ compliance with mental health and substance use disorder (SUD) parity rules. MCOs and states may squirm when they start their time in the hot seat: OIG found that in eight studied states, “states and their MCOs did not conduct required parity analyses…and all eight states may not have ensured that all services were delivered to MCO enrollees in compliance with [mental health]/SUD parity requirements.” OIG also pointed a finger at CMS, blaming the agency for not scrutinizing states’ enforcement of parity rules.

Litigation against health plans over alleged mental health parity violations has proliferated in recent years, with judges notably ruling in favor of UnitedHealth Group and against Elevance Health, Inc. Things may get even more complicated with the Biden administration likely to propose more mental health parity regulation this year, according to attorneys from Manatt, Phelps & Phillips, LLP.

Mental health parity rules, which rely on statutes including the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and the Consolidated Appropriations Act, 2021, require health plans to cover behavioral health and substance use disorder (SUD) treatment at the same level as medical/surgical benefits.

During its March 7 Investor Day, The Cigna Group raised its long-term earnings projection and highlighted the diverse offerings it believes will win client business and differentiate itself from competitors. The company placed particular emphasis on opportunities in the specialty pharmacy area, where it already has a strong foothold and plans on expanding in the coming years.

Cigna increased its long-term adjusted earnings per share (EPS) guidance range to an average growth of 10% to 14% per year, up from a range of 10% to 13%. For 2024, it kept its adjusted EPS target of at least $28.25, up from $25.09 last year.