APA Supports Provisions Being Challenged in Court

In comments submitted last month to the federal government, APA expressed support for two provisions in the federal government's interim final rule interpreting the new mental health parity law that are being challenged in court by some managed behavioral health care organizations (MBHOs).

One requires insurers to use a single deductible for both mental health and medical/surgical services, and the other prohibits the use of nonquantitative treatment limitations (NQTLs) for mental health treatment. The MBHOs in their suit are claiming that both of those provisions will hamper their ability to offer parity coverage of mental health without increasing costs (Psychiatric News, May 7, 2010).

“APA strongly supports the departments' [of Labor, Health and Human Services, and Treasury] inclusion of [NQTLs] as impermissible restrictions under the Mental Health Parity and Addiction Equity Act (MHPAEA), and we believe that this addresses the central intent of the statute,” APA Medical Director James H. Scully Jr., M.D., wrote in the comments. “As we stated in our comments on the [request for information submitted last spring], the most visible methods of controlling costs and perpetuating discrimination, such as visit limits and higher cost sharing, are not always the most insidious. NQTLs prevent patients from gaining access to adequate mental health and substance use disorder treatment, which is the very problem MHPAEA sought to rectify.”

In addition to the strategies prohibited in the interim final rule, APA is urging the government to add further restrictions on insurers' use of several other strategies, such as prior authorization and concurrent review requirements for outpatient services and policy coverage conditions and exclusions.

Additionally, APA expressed its support for the single deductible for all covered services.

“APA would like to express our strong support for the departments' clarification that cumulative financial requirements, such as deductibles and out-of-pocket maximums, must be structured as a single combined limit. We stated in our RFI comments that we fully supported this position and believe that it is far more consistent with the intent of MHPAEA. As stated in the statute, MHPAEA prohibits financial requirements including deductibles and out-of-pocket maximums which are more restrictive than applied to medical and surgical benefits and requires that there be no separate cost-sharing requirements applicable only with respect to mental health or substance use disorder treatment.”