Having just returned from the Innovations in Recovery conference in San Diego with Life of Purpose Treatment founder Andrew Burki, it was my honor to have met and spent time with former Congressman Patrick Kennedy, the champion of the 2008 Mental Health Parity and Addiction Equity Act. However, as was discussed during my presentation, the enforcement of the Parity Act still has some way to go.
First, yesterday CMS issued a press release announcing the formation of the Parity regulations pertaining to Medicaid and the Children’s Health Insurance Program (CHIP) programs. That is great news. More about it can be read here.
Second, and more importantly, enforcement actions in the country are being undertaken by various state attorneys general, most recently New York Attorney General Eric T. Schneiderman, who is trying to make a real difference.
On March 18, 2015, his office announced yet another settlement with a health insurance provider – Excellus Health Plan – for wrongly denying addiction and mental health benefits to thousands of New Yorkers in violation of state and federal parity laws. The settlement requires Excellus—which is part of the Blue Cross Blue Shield Association and has 1.5 million members in upstate New York—to cover residential treatment for addiction and mental illness and overhaul its claims review process for these services. It also requires Excellus to provide notice of a new appeal right to 3,300 members whose claims for addiction and mental health services were previously denied. The new appeals could return up to $9 million to patients.
The Attorney General’s Health Care Bureau’s investigation found that Excellus denied claims for inpatient substance use disorder treatment seven times as often as claims for inpatient medical care. Excellus violated state and federal parity laws that require insurers that provide mental health and substance use disorder benefits to provide them equally—or at parity—with other medical and surgical benefits. According to the Attorney General’s press release, “many of Excellus’s denials were the result of its requirement that members fail outpatient treatment multiple times” before inpatient services would be covered. These “fail twice” policies are harmful to patients. They also violate New York guidelines and, in this case, parity laws since the requirements were not applied to other medical services
The settlement against Excellus is the fifth reached by AG Schneiderman’s Health Care Bureau since last year, making AG Schneiderman’s office a national leader in enforcing the federal parity law. Previously, his office settled with ValueOptions, MVP Health Care, EmblemHealth, and Cigna for parity violations.
Note: Legal Action Center (http://lac.org/) worked successfully with the substance use disorder and mental health fields towards passage of the federal mental health and addiction parity law in 2008. Through their work co-leading the national Coalition for Whole Health, they have been instrumental in securing strong federal rules for covering substance use disorder and mental health treatment at parity with other health benefits to ensure the law is implemented effectively. While the announcement of the settlement was made on the AG’s website, this information was taken from the LAC, and we are very appreciative and supportive of their continuing efforts.