Behavioral Health

New Mental Health Parity Regs Are Unworkable, Insurers Say

Insurer and plan sponsor trade groups strongly oppose the Biden administration’s stepped-up mental health parity regulations, according to statements and public comment letters submitted in response to the latest rulemaking on the subject. Insurer groups AHIP, the Blue Cross Blue Shield Association (BCBSA) and the Alliance of Community Health Plans (ACHP) all lined up against the rulemaking, as did the ERISA Industry Committee (ERIC), a plan sponsor group.

According to the insurer and plan sponsor groups, the proposed rules, which were released in July, are unworkable. They argue that there are simply not enough providers available to meet the more stringent requirements set out in the proposed regulations. The current round of rules, if implemented, would expand the list of conditions covered by parity rules, require additional data reporting and establish stronger network adequacy standards. Both plan sponsors and carriers could be held liable for violations of most provisions in the Biden administration’s proposed regulations.

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News Briefs: Wyden, Pallone Probe Medicaid Prior Authorization Denials

Prominent Democratic lawmakers have launched an investigation following an HHS Office of Inspector General (OIG) report citing high rates of prior authorization denials by Medicaid managed care organizations. That report, which reviewed 2019 claims data from seven multistate MCOs, found that those insurers denied 12.5% of all prior authorization requests — more than double the denial rate of Medicare Advantage plans that same year. Alarmed by the report, House Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-N.J.) and Senate Finance Committee Chair Ron Wyden (D-Ore.) said they sent letters seeking information about prior authorization practices to CVS Health Corp.’s Aetna, AmeriHealth Caritas, CareSource, Centene Corp., Elevance Health, Inc., Molina Healthcare, Inc., and UnitedHealthcare. Among other questions, the lawmakers want “a description of all algorithms, including machine learning and artificial intelligence algorithms” that the companies use when considering prior authorization requests.

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Health Plans Sweat Over Latest Mental Health Parity Regulations

The latest round of mental health care parity regulations would require health plans to detail members’ access to mental health care and the extent of behavioral health networks in much greater detail than before — and a recent federal report says that most plans were not in compliance with previous reporting standards. Experts say that the reporting requirements are a drastic change from previous standards, and plan sponsors and insurers have asked the Biden administration for more time to review the proposed rule.

The Biden administration has made significant changes to regulators' mental health parity enforcement powers in the past, and the latest set may be the boldest yet. The latest proposed rules, issued July 25, include specific data reporting requirements around non-quantitative treatment limits (NQTLs) and more stringent network adequacy requirements. Indeed, insufficient network adequacy now could count as an NQTL for enforcement purposes.

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Researchers Take Closer Look at Virtual Mental Health Care Boom

Now that the COVID-19 public health emergency has ended, the health care system — including insurers — are grappling with how to proceed in the “new normal” amid shifted habits and utilization patterns. To that end, two new studies offer insights into the implications of patients’ growing use of telehealth for mental health care services.

“The COVID-19 pandemic has caused massive amounts of changes in health care delivery, but then also in terms of how individuals are dealing with the pandemic. There’s been extensive research about how anxiety has increased or [how] other mental health disorders have increased,” observes Jonathan Cantor, Ph.D., a policy researcher at RAND Corp. With that in mind, Cantor and his fellow researchers sought to build on a previous study and measure how both telehealth and in-person mental health utilization and spending has changed from 2019 to 2022.

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Large Employers Worry Over Worsening Worker Mental Health, Drug Costs

When asked about the COVID-19 pandemic’s impact on their employees’ health and well-being, a whopping 77% of employers surveyed by the Business Group on Health said they are currently seeing increased mental health issues in their workforce. And based on other findings in the employer coalition’s annual survey, companies are counting on their health plan partners to help them address this growing issue.

According to Business Group on Health Vice President Brenna Shebel, “77% is a stark jump over last year,” when 44% of employers said they were seeing an uptick in conditions such as substance use disorders, depression and anxiety. This year, another 16% of employers said they anticipate seeing an increase in mental health issues in their workforces in the future, “so certainly a key finding here is the dire need for mental health services and supporting their employees as they’re navigating their myriad needs in the area of mental health,” Shebel added during an Aug. 22 virtual press event held to present Business Group on Health’s findings.

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Medicaid Demos for Incarcerated People Offer Chance to Test Critical Interventions

The Section 1115 waiver that allows states to provide limited Medicaid coverage to incarcerated people has drawn applications from 18 states, according to KFF data from Aug. 11. Most of those states have chosen to limit the coverage to specific populations, such as incarcerated people with positive HIV/AIDS diagnoses, substance use disorder (SUD) or serious mental illness (SMI) — and experts say that the varied scope of state uptake could, over time, show which interventions are most effective in helping the vulnerable populations that the waiver is meant to serve.

Per KFF, of the 18 states that have submitted waivers, four — California, South Carolina, Utah and Washington — have had their waivers approved. Fifteen have pending waivers. (Utah and Oregon have both submitted multiple waivers; both of Oregon’s are pending approval from CMS, while Utah has had one approved and one is still under consideration.)

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News Briefs: Connecticut AG Scolds Insurers for High Rate Hike Requests

Connecticut’s top law enforcement official is coming out swinging against big rate hikes requested by health insurers that sell plans in the state’s individual and small-group markets. In an Aug. 15 letter to Connecticut Insurance Commissioner Andrew Mais, Attorney General William Tong points out that the state’s Insurance Dept. may only approve rates that are not “excessive, inadequate or unfairly discriminatory,” and insurers must provide “transparent, factually supported actuarial analysis” to justify their rates. “In at least the case of Cigna’s 14.9 percent increase in the small group market, Anthem’s 9.8 percent increase in the individual group and 14.9 percent increase in the small group market, and ConnectiCare’s 17.5 percent increase in the individual market, the insurers have failed to meet that burden and their requests must be rejected,” Tong wrote.

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Despite Limited Commercial Impact, Vermont’s ACO Test Delivers Results in Medicare

Vermont’s all-payer accountable care organization (ACO), OneCare Vermont (OCV), has reduced Medicare costs but has had minimal impact on the state's Medicaid and commercial segments, a new report commissioned by CMS says. However, the state’s largest carrier — nonprofit commercial insurer Blue Cross and Blue Shield of Vermont (BCBSVT) — withdrew from the program at the end of the 2022 plan year and does not currently plan to return.

The report, prepared by NORC at the University of Chicago on behalf of the CMS Center for Medicare and Medicaid Innovation (CMMI), focused most of its cost and quality improvement analysis on Medicare. The report did not make any quantitative assessments of OneCare Vermont’s impact on the commercial market. NORC found that the ACO reduced gross spending for Medicare enrollees by $686.40 per member per year, or 6.2% per year, during the first four years of implementation, resulting in a $124.9 million net reduction of Medicare spending during those years, a drop of 5.7%. However, quality improvement and utilization assessments were more difficult to make due to the COVID-19 pandemic, which distorted utilization patterns during 2020 and 2021.

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New Proposed Rules Aim to Tackle Stubborn Mental Health Treatment Barriers

The federal government on July 25 issued proposals to strengthen the Mental Health Parity and Addiction Equity Act (MHPAEA) and ensure that health plans are complying with the mandate of providing fair and equal access to mental health and substance use disorder treatment. JoAnn Volk, the founder and co-director of Georgetown University’s Center on Health Insurance Reforms, says HHS and the Labor and Treasury departments are particularly interested in addressing health plans’ reporting and comparative analyses of nonquantitative treatment limitations (NQTLs).

The MHPAEA was enacted in October 2008 and built upon the Mental Health Parity Act of 1996, which prohibited large group health plans from having different annual and lifetime limits for mental health and medical/surgical benefits. However, the agencies did not publish final regulations implementing the MHPAEA until November 2013.

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At AHIP, Medicaid MCOs Talk Behavioral Health Value-Based Contracts

To succeed with value-based behavioral health care contracts, Medicaid managed care plans need to tailor those pacts to the unique needs of a given provider, MCO executives say. And plans may not be able to use risk-based contracts with individual practitioners and other small providers — especially if network adequacy is at stake.

“We really try to think about it in three broad categories: Are we bringing clinical value, operational value or financial value” as a result of a value-based contract? posed Kevin Wheeler, M.D., medical director for practice transformation and value-based contracting strategy at AmeriHealth Caritas, during a June 14 session of the AHIP 2023 conference in Portland, Oregon. “And we’re thinking about this in terms of our relationships with our providers and with our members.”

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