Editor’s Note: In the article below, Manatt Health discusses key policies in the “Improving Mental Health Parity Act,” the latest bill in the bipartisan mental health initiative. Mental Health of the Senate Finance Committee. In a recent webinar, Manatt shared a guide to help health plans navigate the complexities of mental health parity effectively. The program explored parity in mental health from three interrelated perspectives – litigation, regulatory and legislative – to provide a multifaceted look at its impact on health plans and the patients they serve. To view the free CLE-eligible webinar on demand and download a free copy of the presentation, click here.
On December 1, the Senate Finance Committee released the fifth and final discussion draft of the Committee’s Bipartisan Mental Health Initiative. This discussion draft, published by Chairman Ron Wyden (D-OR), Ranking Member Mike Crapo (R-ID) and Committee Members Michael Bennet (D-CO) and Richard Burr (R-NC), aims to address mental health coverage in Medicare and Medicaid. While the Committee describes the Bill as the “Improving Mental Health Parity Act”, several of its provisions do not address “parity” between mental health benefits/disorders. substance use and medical/surgical benefits, which is how federal law currently defines mental health. “parity.” At 21 pages, the proposal includes five policies, representing a relatively modest set of provisions:
- Clarification of outpatient coverage for beneficiaries of Medicare with a SUD. The policy included in the “Medicare Provisions” section would require Medicare to provide guidance to providers “detailing the extent to which partial hospitalization services may be provided to a person diagnosed with a substance use disorder” (SUD ) as well as additional information about other forms of Medicare-covered outpatient services for patients with Medicare SUD.
- Require Medicare Advantage (MA) plans to maintain accurate and up-to-date provider directories. The proposal would codify existing regulatory requirements that PA regimes maintain directories of specific providers. This section also proposes additional requirements for MA Plans to notify CMS in a timely manner (within two days) of changes to a provider’s status in the network and publish directories of plan providers on a public website.
- GAO study comparing coverage of mental health and SUD benefits and non-mental health and SUD benefits. The proposal would require a Government Accountability Office (GAO) study to compare behavioral health benefits under MA plans to non-mental and SUD health benefits under MA as well as mental health benefits and SUD under the original health insurance. The proposal specifically directs GAO to analyze differences in registrant cost sharing and usage management.
- Require accurate and searchable provider directories in Medicaid. This section would codify existing regulations that require Medicaid managed care organizations to maintain “regularly updated” provider directories, including information about whether providers are accepting new patients. The requirements would also apply to state Medicaid fee-for-service programs.
- GAO Report on Disparities in Medicaid Payment Rates for Mental Health and SUD Benefits. Along with the MA GAO report, this section would require the release of a GAO report detailing discrepancies in Medicaid payment rates for mental health and SUD benefits versus medical and surgical services in a sample of states.
Mandatory scans appear designed to generate information that could inform future, more targeted law enforcement initiatives.
The Committee has previously released proposals on telehealth policies, youth mental health, the mental health workforce, and the integration of physical and mental health care providers, all of which are summarized in a Section-by-section summary of the Finance Committee. While some of the provisions in the telehealth and pediatric behavioral health discussion drafts were signed into law in the bipartisan Safer Communities Act earlier this year, the path forward for many other proposed policies remains unclear as management of the committee notes their[intent] rely on” policies in the “coming months”.
To note: More detailed information on all of the Committee’s proposals is available at Manatt on healthManatt’s premium information service. Manatt on health provides in-depth insights and analysis focused on the legal, policy and market developments that matter to you, keeping you ahead of the trends shaping our evolving healthcare ecosystem. Available by subscription, Manatt on health offers a personalized, user-friendly experience that gives you easy access to thought leadership from Manatt Health. To learn more or schedule a demo, contact Barret Jefferds at firstname.lastname@example.org.
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