American Psychological Association Weighs In re: MH Parity Law Battle Looming

Date: May 17, 2010

To: SPTA and Division Federal Advocacy Coordinators
APAGS Coordinators

From: Marilyn Richmond, J.D., Assistant Executive Director for Government Relations
American Psychological Association Practice Organization

Cc: Katherine Nordal, Ph.D., Executive Director for Professional Practice
SPTA Executive Directors
SPTA Directors of Professional Affairs
CAPP

Re: Update on Regulatory Implementation of Federal Parity Law


On February 2 the Departments of Health and Human Services, Labor and Treasury (the Departments), published an interim final rule (IFR) to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). The American Psychological Association Practice Organization (APAPO) supports the IFR, as published, and has urged the Departments to ensure its final implementation. This Information Alert provides information about the IFR, APAPO’s efforts in seeking its final implementation, and a legal action that a group of managed behavioral health organizations (MBHOs) has brought to prevent the implementation of the IFR.

MHPAEA was enacted into law on October 3, 2008, and became effective on October 3, 2009. The law, however, requires the Departments to promulgate regulations that detail compliance with its provisions. Health plans have complied with the law since October 3, 2009, based on their assessment of its requirements. The IFR will generally apply to health plans for plan years beginning on or after July 1, 2010, which means that most plans will have to begin complying with the IFR beginning January 1, 2011.

The IFR fully implements the statutory requirements of MHPAEA by requiring parity for all financial requirements and treatment limitations. The regulation also prohibits the imposition of separate deductibles and out-of-pocket maximums as applied to mental health and substance use disorder benefits and requires parity for “nonquantitative” treatment limitations, such as those related to benefits management. It is anticipated that the Departments will make the rule final at some point later this year after considering comments on the IFR, which were due on May 3. The Departments may make changes to the IFR before finalizing it, based on comments received.

As mentioned, APAPO fully supports the interim rule, as published, and has taken a lead in supporting the Departments in the rulemaking process leading to final implementation. On May 3, APAPO filed comments in support of the rule, as published, emphasizing the importance of applying parity to prohibit separate deductibles and related cost sharing and for the implementation of the law as it applies to nonquantitative treatment limitations, including benefits management. APAPO also wrote and garnered signatures for the Mental Health Liaison Group (MHLG) comments in support of the parity interim rule. The MHLG is the most significant mental health and substance use coalition in Washington, DC. Through APAPO’s efforts, 55 national organizations signed their support for the IFR—the most signatories for any MHLG letter in its long history. Both APAPO’s comments and the MHLG comments in support of the IFR will be made available on the Department of Labor’s website in the coming weeks athttp://www.dol.gov/ebsa/regs/commentsmain.html.

APAPO’s efforts have taken on greater significance since April 1, when a group of MBHOs sued the Departments, asking the US District Court for the District of Columbia for a temporary restraining order (TRO) to block the rule and for a preliminary injunction to stop the rulemaking process from moving forward. The MBHOs argue that the Departments violated federal rulemaking procedure in publishing the rule as they did. They also argue that the Departments overstepped their rulemaking authority by interpreting the statutory language of the MHPAEA to prohibit separate deductibles and to require parity for nonquantitative treatment limitations, specifically as related to benefits management. On April 4 the court denied the TRO and said that it would hear the case regarding issuance of an injunction. The court is expected to hear the request for an injunction shortly in the coming weeks. The court has denied a motion that would allow outside parties to submit amicus curiae briefs and will hear the case as presented only by the parties to the action. While federal regulatory agencies enjoy wide discretion in their rulemaking authority, should the MBHOs prevail, the rulemaking process could be altered and ultimately changes could be made to the rule before it becomes final.

APAPO will keep practitioners informed as the regulatory process moves forward.

Sallie E. Hildebrandt, Ph.D.2010 CPA President Elect4130 La Jolla Village Dr., Ste 301La Jolla, CA 92037Phone: 858-453-1800 FAX: 858-452-3992Email: sehphd@cox.netwww.salliehildebrandtphd.com

NYT: Mental Health Parity Battles Loom at the Federal Level

http://www.nytimes.com/2010/05/10/health/policy/10health.html

"......The fight offers a taste of the coming battle over rules to remake the health care system under legislation pushed through Congress by President Obama.

Insurance companies and employer groups are lobbying the White House to delay and rework the rules on “mental health parity.” Insurers and many employers supported the 2008 law, but they say the rules go far beyond the intent of Congress and would cripple their cost-control techniques while raising out-of-pocket costs for some patients. ....

The goal of the law is to abolish discriminatory insurance practices frequently applied to coverage for the treatment of mental health disorders and substance abuse. Under the law, insurers cannot set higher co-payments and deductibles or stricter limits on mental health benefits than they set for the treatment of physical illnesses like cancer and diabetes. For decades, such disparities have been common. ....

The Blue Cross and Blue Shield Association, Aetna and other insurers have urged the federal government to drop this aspect of the rules. The purpose of the law was to ensure parity in benefits for patients, not “parity in provider reimbursement,” said Justine Handelman, executive director of the Blue Cross and Blue Shield Association.

But Carol A. McDaid, a lobbyist for a coalition of mental health advocates, said, “Patients are not getting access to mental health care because many insurers are not paying enough to cover the cost of services.”...........

City of Asheville School System : Ignoring the Educational Rights of Exceptional Children?

This is correspondence between myself and Julie Ball, education reporter for the Asheville Citizen Times, whom, I am hopeful, will report on the challenges of having an Exceptional Child (EC) whom is also very bright and in honors courses and whom, as re: diagnosis of ADHD, requires MORE structure not LESS structure, as re: learning and a school environment.

________________________________________________________________
Thanks for your follow-up note, Julie Ball, education reporter of the Asheville Citizen Times.

I am hopeful that you can write an article about EC children whom are commonly perceived as of below average intelligence. This is not so and the dispelling of that matter would be of interest to readers, I believe.

Moreover, as a clinical psychologist, whom has not infrequently diagnosed ADHD and commonly overlapping learning disabilities in adults, there is a significant misunderstanding of the challenges that EC people in general, if you will, experience in carrying out everyday activities.

This is perhaps more detail that you want to know but I want to outline the problem of removing an EC child who is simultaneously advanced, from school, for having in his book-bag a pocket knife which was pointedly not bought to the IEP/determination manifestation meeting we had last week w/ Mr. Paretta, EC Director of City of Asheville School System; Mr. Greg Townsend, principal of SILSA; Linda Anderson, Special Education Teacher; Lisa Sessions, English teacher; Amy Cornett, also working w/ EC children for City of Asheville Schools; Les & his parents; and, a witness whom digitally recorded the meeting..

Both my husband and I were refused the viewing of the pocket knife, which we know well, and which Leslie has had for a couple of years; this is not an aberrant item for adolescent boys to have.

As parents, we certainly do support the school for creating a safe environment.

As the school well understands, there is no history of angry outbursts or violent behaviors as per Leslie.

I have asked NC Disability Rights for a summation of our rights as parents re: the rules of evidence which created a chain of events which we necessarily had to address or allow Leslie to fail the 9th grade.

Moreover, his diagnosis of ADHD, which was made in the 2nd grade, and which then caused the creation of an IEP, made absolutely no difference to the school system. We advised them that Leslie needs MORE structure not LESS and so as per their actions they created a situation which had to be addressed and so I hired the tutor(s) which I expect to be reimbursed for.

I am hopeful of speaking to you soon.
Sincerely, Marsha V. Hammond, PhD

cc: City of Asheville School System employees
Madame Defarge NC Mental Health Reform blogspot (which I maintain and which concerns itself w/ mental health matters of NC citizens).

Cherry Hospital May (Again) Lose Its Ability to Bill Medicare/ Medicaid Due to Insufficient Staffing/ Danger to Patients

.....from the journalist, Michael Biesecker:

"...In recent months, employees at Cherry have complained about insufficient staffing and a rising level of violence within the facility. State budget cuts have reduced resources at the four state-run psychiatric hospitals, even as the number of people needing treatment has continued to climb after a failed effort to reform North Carolina's mental health system.

The hospital will now submit a plan to the federal Centers for Medicare and Medicaid to fix the problems found in the latest inspection. Regulators will then determine whether the hospital can continue to receive federal insurance reimbursements, which typically run about $800,000 a month.

Read more: http://www.newsobserver.com/2010/05/01/462054/cherry-hospital-faces-a-new-citation.html#ixzz0mhxVhJ58

___________________________________________________________
Cherry Hospital was cited in 2008 in a similar manner & followed on Defarge:

http://madame-defarge.blogspot.com/2008/08/steven-sabock-unimportant-man-who-died.html

http://madame-defarge.blogspot.com/2008/08/cherry-hospital-nc-zimbardos-unusual.html