APA is applying a “full-court press” to the enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA), demanding that insurers abide by the provisions of the 2008 law.
In September, APA filed an amendment to its complaint against Anthem Health Plans Inc. in Connecticut and its parent company, Wellpoint Inc. (Psychiatric News, April 15). Also joining in the amended action are the Connecticut Psychiatric Society and the Connecticut Council for Child and Adolescent Psychiatry.
The original lawsuit was filed in April and maintains that Anthem is in violation of the MHPAEA and Connecticut’s insurance parity law as a result of changes the company made to its rate schedules for services provided by psychiatrists after changes to CPT codes went into effect in January.
The complaint asked the court to fix problems inherent in the defendants’ rate schedules that make it more difficult or expensive for patients to receive psychotherapy from a psychiatrist. The complaint alleges that through its rate schedule, Anthem is forcing psychotherapy patients to make two appointments, thus missing more time from work and imposing an unfair financial burden on them. It also calls for fixes to Anthem’s practice of reimbursing psychiatrists less than other physicians for evaluation and management services.
The amended complaint was filed because, in the words of APA President Jeffrey Lieberman, M.D., “Sadly, neither Anthem nor the Connecticut Insurance Division have made any effort to solve the problem.” He added that the insurer’s action “is an example of the kinds of barriers to care insurance providers impose on people with mental illness….The MHPAEA is a good law that needs to be enforced so that people in need of mental health care do not slip through the cracks. We can no longer tolerate discriminatory practices that impede access to care.”
The amended complaint is just the latest in a series of actions, including direct litigation, support for litigation by others, correspondence and meetings with insurance administrators, education of state insurance commissioners, testimony before state legislatures, and a public-relations campaign, that have resulted in scores of articles in the medical and lay press about APA’s demand for compliance with the law.
In some cases, correspondence with insurers has resulted in a change in their policies. For instance, following an exchange with senior executives of Highmark Health Plans, AmeriBen, and others about those companies’ implementation of new CPT codes for mental health—which APA contended was in violation of MHPAEA by discriminating against patients receiving psychotherapy—the companies adjusted their payment policies for evaluation and management codes and the psychotherapy add-on codes, which would reimburse physicians for psychotherapy. APA is in active discussions with some Blue Cross Blue Shield Plans, Value Options, and other major insurance carriers.
APA has also assisted plaintiff’s counsel in a case in Vermont in which, the plaintiff patient—identified only as “C.M.”—alleges that the insurer violated the MHPAEA by requiring preapproval for routine mental health services but not for other medical services, by conducting concurrent reviews of mental health services but not requiring such reviews for other medical services, and by initiating automatic review processes triggered by a fixed number of visits for mental health services but not for other services.
In May a federal court ruled that the Vermont case could go forward, saying that if insurance companies are going to treat mental and physical illnesses differently, they must justify the disparities using clinically appropriate standards. That ruling was in response to a “motion to dismiss” filed by the insurer, Fletcher Allen Health Care Inc. (Psychiatric News, May 23, 2013).
Additionally, APA is providing support to a class-action suit filed by the New York State Psychiatric Association against UnitedHealth Group and subsidiaries, including United Behavioral Health (UBH), for alleged violations of the federal parity law and the Affordable Care Act.
A 100-plus-page formal complaint details the violations alleged by NYSPA and individual beneficiaries. These include “numerous member complaints” about United’s restrictions on psychotherapy. “NYSPA members have reported United fully curtailing psychotherapy for patients requiring long-term treatment, allowing no more than weekly psychotherapy for patients who have attempted suicide and been hospitalized (in one case a patient attempted suicide five times and was hospitalized 10 times), and refusing to cover more than one weekly session of psychotherapy for actively suicidal patients,” according to the complaint.
The document states that NYSPA members have also complained about United beneficiaries’ reporting “extreme difficulty obtaining initial and continuing authorizations for intermediate levels of care, such as intensive outpatient treatment and partial hospitalization for mental health and substance abuse disorders.”
Colleen Coyle, J.D., general counsel for APA, told Psychiatric News in April that the lawsuit is the beginning of a public battle to enforce parity laws. “Unfortunately, what the plaintiffs complain about—insurer manipulation of nonquantitative treatment limitations, CPT code changes, provider reimbursement rates, and documentation requirements in order to deprive mental health patients of the benefits for which they have paid—is not unique to United or to New York,” she said (Psychiatric News, April 5).
APA President-elect Paul Summergrad, M.D., said that though it has been five years since the MHPAEA was passed, insurance companies continue to violate the rights of mental health patients and impede physicians’ ability to care for them. “A final federal rule is critical in order to end this discrimination,” he said. “The lack of final guidance on crucial issues such as intrusive utilization review and prior authorization even for emergency and inpatient psychiatric services allows insurers to find ways to evade their responsibilities. My hope for the near future is that members, state associations, and APA will continue to unite in the fight for parity to improve access for effective treatment and to reverse public sector cuts to care. It’s time for psychiatric patients to finally receive equitable and high-quality care.” ■