Coalition Letter on Medicaid Parity
On March 28, 2019 the Maryland Department of Health (MDH) submitted its final report to the Centers for Medicare & Medicaid Services on the Maryland Medicaid program’s compliance with the Mental Health Parity and Addiction Equity Act (Parity). After reviewing the report, the Maryland Parity at 10 Coalition sent a letter raising concerns about the Department’s analysis and general conclusion of Parity compliance. MDH has not presented the information and analysis that is required under CMS’s Parity toolkit. The Coalition requested a meeting to discuss concerns, including ensuring compliance for utilization management and reimbursement.
Provider Parity Act Knowledge and Practice
Key findings from the February 11, 2019 final report on a 2018 survey of provider knowledge about the Mental Health Parity and Addiction Equity Act (Parity Act) revealed:
- The majority of providers reported that their patients face insurance-related barriers to accessing services for mental health and substance use disorders.
- Providers reported that they try to find a way to continue needed services when patients’ claims for mental health or substance use services are denied.
- Providers reported facing barriers to assisting their patients in addressing denials of mental health and substance use disorder benefits.
- Responses suggest a lack of knowledge and/or lack of confidence in their knowledge about the Parity Act. (For educational resources and other information, view the MPS Parity Toolkits page.)
Exhibit C of the report breaks out responses by state, with 140 of the 677 total from Maryland.
Concerns on Preliminary Medicaid Parity Analysis
In October 2018, the Maryland Parity at 10 Coalition, which includes the MPS, sent a letter to Secretary Neall noting key priorities, including the need for review of prior authorization and other utilization management requirements and the setting of reimbursement rates to ensure non-discriminatory standards. Pending the submission of MDH’s final compliance report, the coalition explained its concern regarding MDH’s assertion “that ‘the setting of provider rates falls outside the scope of MHPAEA parity requirements.’ In fact, federal regulations and guidance make crystal clear that the Parity Act governs the setting of reimbursement rates as a non-quantitative treatment limitation. 42 C.F.R. § 440.395(b)(4)(ii). We request that this compliance information be included in the final Parity compliance report.” The letter goes on to express interest in the MDH’s proposed rate-setting study while stating, “that study differs from a Parity Act analysis, which requires an assessment of the ‘processes, strategies, evidentiary standards, or other factors,’ as written and in operation, to ensure that they are comparable to and applied no more stringently to MH and SUD benefits than to medical/surgical benefits.” The Maryland Parity at 10 Coalition will continue to work with MDH to ensure that the full potential of the law is realized in our state’s Medicaid and Children’s Health Insurance programs.
Maryland Parity at 10 Policy Brief
The MPS participates in the Maryland Parity at 10 Coalition, which issued an important brief last month calling for an end to discriminatory insurance coverage. This brief outlines five action steps that elected officials should implement:
- Vigorously enforce state and federal parity laws through consumer and provider education, insurance department and Medicaid compliance reviews, and Attorney General Investigations.
- Verify that plans are in full compliance prior to plans being offered by collecting and approving health plans’ parity compliance analyses.
- Conduct regular parity market conduct examinations and data audits to check for plan compliance.
- Create consumer assistance services to help consumers navigate insurance denials.
- Create a consumer-friendly complaints process and investigate all MH/SUD complaints for potential parity violations.
Even though we have groundbreaking laws on the books at both the state and federal levels, their promise has not been achieved due to inadequate enforcement. “Despite clear rules from the federal government on health plans’ obligations under the Federal Parity Act, Maryland regulators do not thoroughly reviewed plans’ written policies and actual practices to ensure parity compliance.” The brief supports these arguments with Maryland data from the Milliman study as well as Insurance Administration correspondence.
Follow the progress of Parity at 10, a three-year campaign that will establish effective models for robust enforcement of the Parity Act in 10 states and disseminate those models across the country. The MPS is a member of the Maryland Parity at 10 Coalition. The campaign is looking for stories about individuals’ experiences with insurance barriers. This story-banking effort will support advocacy for better coverage and improved access to mental health and substance use treatment. The website also has a useful resource bank that can be filtered for Maryland-specific or provider-specific information.
MPS Advocacy on Parity Accreditation
The Clear Health Quality Institute (CHQI) published a Draft Mental Health Parity Accreditation Program Standards and Guide with a request for feedback. In coordination with the APA and other parity advocates, the MPS expressed concern that adoption of these standards would ultimately undermine patient care and the progress on mental health parity that has been achieved to date. Several major problems were noted.
- First is the limitations of an accreditation program to improve enforcement of a civil rights law and the risk that it might confer a “seal of approval” that is misleading since the question of whether the non-discrimination tests are met in a specific situation requires legal judgment.
- Second, the draft standards are incomplete since they do not include essential metrics, such as full data on denial rates and out-of-network utilization, or full disclosure regarding the source information and/or evidentiary standards used to define the factors upon which NQTLs are based.
- Third is the lack of robust infrastructure and personnel with qualified parity experience to review applicants.
- Finally, it is unclear to whom and to what the status of any accreditation would apply. The vast array of health plans in the marketplace, e.g. commercial arrangements, self-insured plans, etc., many with subcontractor functions built in makes it very complicated to clarify who the applicant is and the scope of what their accreditation status means. Every component is integral to a parity compliance evaluation.
The MPS also noted that the Federal Self Compliance Tool is available to any health plan that wishes to be transparent and demonstrate compliance. It can simply follow and document the process outlined in this newly issued Compliance Tool and publicly post the results. Click here for the MPS comment letter.
Patients need your help to enforce mental health parity!
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) applies to large group employer plans (+50 people), Medicaid managed care arrangements and nonfederal government plans that do not opt out. The Affordable Care Act (ACA) expanded MHPAEA to Medicaid expansion plans, Exchange Plans and to the individual and small group markets. Right now, MHPAEA impacts almost all insurance products on the market, and your patients need your help in dealing with possible parity issues and ensuring access to care. What can you do? Please click here for step by step directions and helpful websites.
- Help patients understand their rights under the federal mental health parity law by making this poster available in your office.
- SAMHSA has a tri-fold brochure that can be distributed in waiting areas to alert patients to their rights and protections under the parity law.
Report Parity Violations
The Parity Track website has a place to register complaints about health plans’ denial or restriction of care. Parity Track partners include the Kennedy Forum and the Scattergood Foundation; its coalition also includes Mental Health America, NAMI and others.