David Shillcutt, Senior Counsel in the Health Care & Life Sciences practice, in the firm’s Washington, DC, office, was quoted in Law360, in “3 Questions About DOL's Mental Health Parity Push,” by Kellie Mejdrich. (Read the full version – subscription required.)
Following is an excerpt:
The U.S. Department of Labor has vowed to continue its aggressive enforcement of a law requiring employer health plans to provide equal coverage for mental health and addiction treatments and other types of medical care, despite expected political pressure from the Republican-led U.S. House of Representatives.
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 sat on the books for more than a decade before Congress decided federal regulators needed sharper teeth to get plans to comply and tucked powerful new authority for the DOL into a massive December 2020 spending bill. …
Here are three questions benefits attorneys have about the DOL's push to enforce the mental health parity law with the GOP in control of the House.
How Hard Will the Republican House Push Back? …
David Shillcutt, senior counsel at Epstein Becker Green, said, "I could imagine Congress taking an interest in the extent to which provider reimbursement itself is considered to be a limit on services that would be subject to parity, as opposed to merely a factor in the design of provider networks."
Shillcutt explained that's because there's "ambiguity about how parity applies to provider networks and the extent to which provider reimbursement rates in particular are subject to parity." …
How Will Proposed Rules Clarify Compliance? …
Shillcutt said there's a "laundry list" of items that plans and issuers want in the proposed rule, but among the most important would be definitions for "factors, sources and evidentiary standards" that plans need to analyze for compliance with parity requirements. …
Are Intellectual and Developmental Disabilities Mental Health Issues?
Another issue attorneys including Shillcutt and Hall said they'd like to see clarified has to do with how the regulator characterizes different kinds of intellectual and developmental disabilities under parity.
"To date, there is no federal guidance that clearly answers that question, and we have seen inconsistency among both federal and state regulators in the extent to which intellectual and developmental disabilities, including autism, in particular, are considered behavioral health conditions," Shillcutt said.
"Many Medicaid agencies have defined them to be medical/surgical conditions, and [the Centers for Medicare and Medicaid Services] has approved those decisions, but yet the Department of Labor has taken enforcement against plans for limits on benefits for those conditions under parity," Shillcutt added. …
Shillcutt said more broadly, "The open question going forward is, what is the problem that is going to be solved through parity enforcement very specifically?"
"And what types of plan benefit designs or operations are going to be identified as violations that need to be changed, as opposed to more reporting that does not lead to any changes that have any significance to beneficiaries?" Shillcutt asked.
