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Parity Update

Parity Update. California Parity Field Hearing July 1, 2013. Background. 2008 –The Mental Health Parity & Addiction Equity Act (MHPAEA) becomes law; fully effective 1/1/2011 2010 –The Affordable Care Act (ACA) becomes law. What is Parity & Why it Matters.

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Parity Update

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  1. Parity Update California Parity Field Hearing July 1, 2013

  2. Background • 2008 –The Mental Health Parity & Addiction Equity Act (MHPAEA) becomes law; fully effective 1/1/2011 • 2010 –The Affordable Care Act (ACA) becomes law

  3. What is Parity & Why it Matters • State of being equal; especially regarding status or pay • Historic discrimination in access to care • Higher out-of-pocket spending • Life expectancy < 30 years • Final regs implementing MHPAEA lagging

  4. IFR Requires 6 Classes of Benefits • Parity regulations set up 6 classes of benefits: • Inpatient in & out-of-network • Outpatient in & out-of-network • Emergency care • Prescription drugs • Parity Implementation Coalition supports adding: • Intermediate inpatient in & out-of-network • Intermediate intensive outpatient in & out-of-network

  5. 3 Key Parity Issues Must be Resolved • Transparency & disclosure of medical criteria & plan terms • Without disclosure, no compliance testing is possible • Non-quantitative treatment limits • Need quantitative floor (i.e. 50%) to operationalize parity in medical management • Scope of service • Plans are excluding essential levels of MH/SUD care; including MAT

  6. Affordable Care Act & Parity • In 2014, ACA expands MHPAEA & will apply to: • Benefits provided in new “exchanges” • Benefits provided by non-grandfathered small group & individual plans • Benefits provided to new Medicaid population • These plans will have to offer a MH/SUD benefit

  7. Lawsuits Alleging MHPAEA Violations • C.M. vs. Fletcher Allen Health Care • U.S. District Court of VT found plans, rather than patients, have the burden of proof to provide clinically appropriate standards of care to justify treating MH/SUD claims differently than medical • APA & CT Psychiatric Society filed suit against Anthem in CT • Anthem agreed to use proper CPT codes but other parity issues still pending • Class action suit filed in NY by NY State Psychiatric Association against UnitedHealth • Key issue: More stringent medical management (NQTL violation) • More lawsuits to come

  8. Resources • Parity Implementation Coalition • www.parityispersonal.org • States & public plans • CMS Center for Consumer Insurance Information & Oversight (CCIIO) • 877-267-2323 ext 61565 • E-mail: Phig@cms.hhs.gov • Employer plans • DOL Employee Benefits Administration • 866-444-3272 • www.askebsa.dol.gov • CA Insurance Commissioner Consumer Assistance Office • 1-800-927-HELP (800-482-4833 TDD) • www.insurance.ca.gov/0100-consumers/0020-healthrelated/

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