Editor’s Note: In the article below, Manatt Health discusses the key policies of the “Mental Health Parity Improvement Act,” the most recent bill from the Senate Finance Committee’s bipartisan mental health initiative. . In a recent webinar, Manatt shared a guide to help health plans effectively navigate the complexities of mental health parity. The program explored mental health parity from three interlocking perspectives—litigation, regulation, and legislation—to provide a multifaceted look at its impact on health plans and the patients they serve. To view the free, CLE-eligible on-demand webinar 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, posted by Chairman Ron Wyden (D-OR), Ranking Member Mike Crapo (R-ID), and committee members Michael Bennet (D-CO) and Richard Burr (R-NC), seeks address mental health coverage. in Medicare and Medicaid. Although the Committee describes the bill such as the “Mental Health Parity Improvement Act,” several of its provisions do not address “parity” between mental health/substance use disorder benefits and medical/surgical benefits, which is how federal law defines mental health “parity” today. In 21 pages, the proposal includes five policies, representing a relatively modest set of provisions:
- Clarification of Outpatient Coverage for Medicare Beneficiaries with 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 an individual with a diagnosis of substance use disorder” (SUD), as well as Additional information about other forms of Medicare-covered outpatient services for Medicare patients with SUD.
- Require Medicare Advantage (MA) plans to maintain accurate and up-to-date provider directories. The proposal would codify existing regulatory requirements for MA plans to maintain accurate provider directories. This section also proposes additional requirements for MA plans to notify CMS in a timely manner (within two days) of changes in a provider’s in-network status and to post the plan’s provider directories on a public website.
- GAO study comparing coverage of SUD and mental health benefits and SUD and non-mental health benefits. The proposal would require a study by the Government Accountability Office (GAO) to compare behavioral health benefits under MA plans with non-mental and SUD benefits under MA, as well as mental health benefits and SUD under Original Medicare. The proposal directs the GAO specifically to analyze the differences in the management of use and distribution of affiliate costs.
- Requirement for 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 on 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. In parallel with the MA GAO report, this section would require the publication of a GAO report detailing discrepancies in Medicaid payment rates for mental health and SUD benefits compared to medical and surgical services in a sample of states.
Mandatory analytics appear designed to generate information that could inform future, more targeted compliance initiatives.
The Committee previously published proposals on telehealth policies, youth mental healthMental health staffY integrating physical and mental health care providers, all of which are summarized in a section-by-section Finance Committee abstract. While some of the provisions in the pediatric behavioral health and telehealth discussion drafts were enacted into the bipartisan Safer Communities Act earlier this year, the path forward for many of the other proposed policies remains unclear as that the leadership of the Committee grades their “[intent] to build on” the policies in the “coming months”.
Note: More detailed information on all of the Committee’s proposals is available through Manatt in HealthManatt’s premium information service. Manatt in Health provides detailed information and analysis focused on the legal, political and market developments that matter to you, keeping you at the forefront of the trends that shape our evolving healthcare ecosystem. Available by subscription, Manatt in Health offers an easy-to-use, personalized experience that gives you easy access to Manatt Health’s industry-leading thought leadership. For more information or to schedule a demo, contact Barret Jefferds at bjefferds@manatt.com.