Kevin Malone, Member of the Firm in the Health Care & Life Sciences practice, in the firm’s Washington, DC, office, was quoted in Bloomberg Law Daily Labor Report, in “Mental Health Parity Rule Pushes Employers to Rethink Status Quo,” by Lauren Clason. (Read the full version – subscription required.)
Following is an excerpt:
A new federal rule will spur employer-sponsored health plans to take a broad look at how they provide mental health benefits compared to those for medical and surgical treatments to ensure they’re meeting strengthened requirements.
The rule (RIN: 1210-AC11) finalized Sept. 9 by the departments of Health and Human Services, Labor, and Treasury aims to strengthen access to mental health care by requiring health plans to perform detailed comparisons between mental health and medical coverage. …
Most clients already have robust parity programs in place, which makes it easier, said Kevin Malone, who advises health plans on mental health parity as a member of Epstein Becker & Green P.C. But uncertainty still exists.
“There’s no way to be 100% certain that you’re compliant because you’re rebutting a presumption of discrimination,” he said, adding, “But we know where to start.”
Revisiting the Status Quo …
The industry is awaiting further guidance for now, Malone said. Clients are specifically looking for metrics the departments will use to evaluate whether a plan is meeting the rule’s thresholds on NQTLs for everything from provider admission criteria to audits and investigations to exclusions and claims denials.
“All of those are subject to parity and they’re all very different activities,” he said. “So the data you’re supposed to use to sort of evaluate the disparate impact of those functions, if they’re discriminatory or not—just figuring out what the data is something of a challenge.”
He pointed to network adequacy standards—which help determine whether enrollees have sufficient access to both mental health and traditional medical providers—as an example of requirements that could have an outsize impact on broader plan design. The agencies solicited feedback in the proposed rule that they plan to use in future guidance.
“This could be an enormous deal if the tri-agencies go forward and finalize basically a new network adequacy standard,” he said. “That is just for the purposes of parity, but it still applies to the whole benefit package.” …
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