MPS Recommends Questions for Third MIA Parity Survey

On August 16, 2017  the MPS submitted suggested questions (3rd market conduct survey) for the Maryland Insurance Administration’s (MIA) third market conduct survey regarding compliance with the Mental Health Parity and Addiction Equity Act (Parity Act).

Question 1 collects details about prescriptions and authorizations for mental health medications broken down into branded and generic, as well as the same for somatic medications.  Our members report a significant increase in the use of medical management procedures, such as prior authorizations, for psychiatric and addiction medications, even for medications that are generic or inexpensive. These medical management policies create barriers to timely access to medications, and may result in worse outcomes.  The MPS also submitted anecdotes (Prior Auth Examples) from its listserv illustrating the problems in this area.

Question 2 gathers data on MH/SUD providers who have submitted claims for outpatient visits within the past 6 months, separated by in and out of network.  The results will provide an estimate of actual availability to patients who need an appointment with a new provider. If MH/SUD providers are less available than somatic providers, this may be evidence of a Parity Act violation.  Additionally, high proportions of out-of-network claims suggest the lack of adequate access to in-network outpatient services.

Along with the two survey questions above, we offered recommendations related to the MIA role in ensuring the Parity Act is fully implemented:

1. We encourage MIA to regularly monitor all commercial plans for parity compliance.
2. We suggest that MIA add checkboxes for Mental Health Parity, Substance Use Disorder Parity, and Network Adequacy on its consumer complaint form.
3. Remove the “evidence of harm to consumers” threshold as a requirement for sanctions to be issued.

 

MPS Recommends Questions for Third MIA Parity Survey

On August 16, 2017 the MPS signed on to recommended questions (MIA Third Market Conduct Survey Questions) prepared by a group of advocates for the Maryland Insurance Administration’s (MIA) third market conduct survey regarding compliance with the Mental Health Parity and Addiction Equity Act (Parity Act).

The questions are designed to uncover disparities in the application of key NQTLs and lead to an investigation of underlying implementation standards that may violate

the Parity Act. We also made a general request that the MIA gather data from the carrier’s third party vendors, as applicable, to evaluate all carrier representations of compliance with the Parity Act.  Carriers may not monitor the processes of their managed behavioral health organizations and may not be aware of network, reimbursement rate or medical management standards that are implemented by their third-party vendors.

The questions address a broad range of concerns, including facility contracting, reimbursement rates, utilization management standards and their application, adverse decisions and external review.  The link above includes the detailed suggestions submitted by the group.

 

Third Market Conduct Survey Issued

The third MIA market conduct survey regarding compliance with the parity act was issued October 6.  In August, the MPS submitted recommendations for possible survey questions, and also signed on to suggestions prepared by the advocate group.  It appears that most if not all of our questions are included in the survey in some way.  In particular, the MIA will examine whether prior authorizations are required for psychiatric medicines more often than for other medicines, which would violate the parity act.  Also, questions related to provider networks will illuminate their adequacy for mental health and substance abuse treatment compared with other medical treatment, which could be a violation.   The MIA aims to complete its third exam by summer 2018.  Please click here for a copy of the survey.