Mental Health Parity and Addiction Equity Act: Final Rule Constituency Briefing

Mental Health Parity and Addiction Equity Act: Final Rule Constituency Briefing


>>GOOD AFTERNOON, AND WELCOME
TO THIS BRIEFING ABOUT THE MENTAL HEALTH PARITY AND
ADDICTION EQUITY ACT FINAL RULE. THIS IS TRULY A HISTORIC AND
WATERSHED EVENT. THERE ARE MILLIONS OF AMERICANS
WITH MENTAL HEALTH CONDITIONS OR SUBSTANCE USE DISORDERS WHO DO
NOT HAVE ADEQUATE PROTECTIONS TO ENSURE ACCESS TO TREATMENT, AND
BETWEEN THE INCREASED COVERAGE BY THE AFFORDABLE CARE ACT AND
THIS LAW, ALMOST 62 MILLION AMERICANS WILL HAVE INCREASED
ACCESS TO MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES.
MY NAME IS PAM HYDE, I’M THE ADMINISTRATOR OF THE SUBSTANCE
ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION.
WE’RE HERE TODAY TO TALK ABOUT THIS REG WHICH WAS RELEASED
TODAY. THE DEPARTMENTS OF HEALTH AND
HUMAN SERVICES, LABOR, AND THE TREASURY JOINTLY ISSUED FINAL
RULES REGARDING PARITY FOR CONSUMERS ENROLLED IN GROUP
HEALTH PLANS WHO NEED TREATMENT FOR MENTAL OR SUBSTANCE USE
DISORDERS. THE MENTAL HEALTH PARITY AND
ADDICTION EQUITY ACT MAKES IT EASIER FOR THESE AMERICANS TO
GET THE CARE THEY NEED BY PROHIBITING CERTAIN
DISCRIMINATORY PRACTICES THAT LIMIT COVERAGE FOR MENTAL HEALTH
CONDITIONS OR SUBSTANCE USE DISORDER TREATMENT AND SERVICES.
THE RULES PROHIBIT GROUP HEALTH INSURANCE PLANS TYPICALLY
OFFERED BY EMPLOYERS FROM RESTRICTING ACCESS TO CARE BY
LIMITING BENEFITS AND REQUIRING HIGHER PATIENT COSTS THAN THOSE
THAT APPLY TO GENERAL MEDICAL OR SURGICAL BENEFITS.
THE FINAL MHPAEA RULES WERE BASED ON THE DEPARTMENT’S REVIEW
OF MORE THAN 5400 PUBLIC COMMENTS, ON THE INTERIM FINAL
RULES THAT WERE ISSUED IN 2010. THE AFFORDABLE CARE ACT
SIGNIFICANTLY EXTENDS THE REACH OF MHPAEA’S REQUIREMENTS,
STARTING IN 2014, ALL NON-GRANDFATHERED SMALL GROUP
AND INDIVIDUAL MARKET PLANS MUST COMPLY WITH FEDERAL PARITY
REQUIREMENTS. QUALIFIED HEALTH PLANS OFFERED
THROUGH THE HEALTH INSURANCE MARKETPLACES IN EVERY STATE MUST
INCLUDE COVERAGE FOR MENTAL HEALTH CONDITIONS AND SUBSTANCE
USE DISORDERS AS ONE OF THE 10 CATEGORIES OF ESSENTIAL HEALTH
BENEFITS. THE RULE IS A BEGINNING TO OTHER
ASPECTS OF PARITY IN THE LIVES OF PEOPLE WITH BEHAVIORAL HEALTH
CONDITIONS. EMPLOYMENT, HOUSING, PREVENTION
AND WELLNESS, MEANINGFUL COMMUNITY LIVING, NONE OF THESE
CAN HAPPEN WITHOUT GOOD QUALITY BEHAVIORAL HEALTHCARE.
I’VE ASKED SOME OF THE EXPERTS FROM THE THREE DEPARTMENTS THAT
WORKED ON THE FINAL RULE TO HELP ME HERE TODAY TO EXPLAIN SOME OF
THE PROVISIONS. AMY TURNER FROM THE DEPARTMENT
OF LABOR, JIM MAYHEW, TO MY IMMEDIATE LEFT, AND IN THE
MIDDLE, KIRSTEN BERONIO. WE’RE GOING TO GET STARTED BY ME
ASKING EACH OF THEM A FEW QUESTIONS, THEN WE WILL
EVENTUALLY OPEN IT TO THE AUDIENCE AND HAVE THE OPERATOR
LET US KNOW IF PEOPLE HAVE QUESTIONS FROM THOSE OF YOU WHO
ARE WATCHING TODAY OR LISTENING TODAY.
SO LET ME START WITH JIM. JIM, WOULD YOU PLEASE PROVIDE US
WITH AN OVERVIEW OF THE KEY CHANGES IN THE FINAL RULE
RELATED TO THE NON-QUANTIFIABLE TREATMENT LIMITS OR WHAT WE CALL
NQTLS?>>THANK YOU VERY MUCH.
THE FINAL RULE GENERALLY PERTAINS TO PROVISIONS IN THE
INTERIM FINAL RULE SETTING FORTH THE PARITY REQUIREMENTS WITH
RESPECT TO NQTL. UNDER BOTH THE INTERIM FINAL
RULES AND THE FINAL RULE, A PLANNER MAY NOT IMPOSE AN — ANY
CLASSIFICATIONS UNLESS THE PROCESSES, STRATEGIES, OR OTHER
FACTORS USED IN APPLYING NQTL TO THOSE — ARE COMPARABLE TO THOSE
FACTORS APPLIED TO THE MEDICAL/SURGICAL BENEFITS IN THE
SAME CLASSIFICATION. NOW THE INTERIM FINAL RULE ALSO
CONTAINED AN EXCEPTION TO THE STANDARD, ALLOWING FOR VARIATION
TO THE EXTENT RECOGNIZED CLINICALLY APPROPRIATE AND WITH
THE CARE WOULD PERMIT A DIFFERENCE.
IN CONSIDERATION OF THE COMMENTS RECEIVED IN RESPONSE TO THE
INTERIM FINAL RULE AND ALSO IN CONSIDERATION OF THE CONFUSION
THAT WAS CAUSED BY THE PERCEPTION, THE FINAL RULE
ELIMINATES THIS PERCEPTION TO THE NQTL STANDARD.
INSTEAD, PLAN ISSUERS WILL CONTINUE TO HAVE THE FLEXIBILITY
TO TAKE CLINICALLY APPROPRIATE STANDARD OF CARE INTO ACCOUNT IN
APPLYING THE NQTL STANDARDS TO ESTABLISH MEDICAL MANAGEMENT
TECHNIQUES. IN PARTICULAR, THIS RESULT ALONE
BETWEEN THE MENTAL HEALTH AND SUBSTANCE ABUSE BENEFITS AND
MEDICAL/SURGICAL BENEFITS DO NOT — VIOLATE THE PENALTY
STANDARDS AS LONG AS THESE REQUIREMENTS — AS LONG AS THE
PROCESS — STANDARD OR OTHER FACTORS USED IN APPLYING THE
NQTL ARE COMPARABLE ON BOTH SIDES.
IN OTHER WORDS, IF THE SAME FACTORS AND STANDARDS ARE USED
TO DEVELOP THE NQTL ON A MENTAL HEALTH/SUBSTANCE SIDE ARE THE
SAME AS THE USE ON THE MEDICAL/SURGICAL SIDE, IT IS NOT
A PARITY VIOLATION IF THE RESULT IS THAT THE NQTL IS APPLIED MORE
FREQUENTLY ON THE MENTAL HEALTH AND SUBSTANCE ABUSE SIDE.
ACCORDINGLY, THE STANDARD ITSELF WITHOUT THE EXCEPTION ALREADY
ACCOUNTS FOR THE RECOGNIZED CLINICALLY APPROPRIATE STANDARDS
OF CARE THAT WOULD PERMIT A DIFFERENCE IN THE APPLICATION OF
THE NQTL TO THE MENTAL HEALTH OR SUBSTANCE ABUSE BENEFIT.
THE FINAL RULE PROVIDES EXAMPLES OF HOW HEALTH PLANS AND INSURERS
CAN COMPLY WITH THE NQTL STANDARD AND ILLUSTRATE THE
FLEXIBILITY PROVIDED IN THE PARITY STANDARD WITHOUT THIS
PERCEPTION.>>THANKS, JIM.
SO KIRSTEN, ONE OF THE THINGS THAT WE’RE DOING HERE IS TRYING
TO UNDERSTAND WHAT THE DIFFERENCE IS BETWEEN THE FINAL
RULE AND THE INTERIM FINAL RULE, SO CAN YOU HELP US JUST REMEMBER
WHAT THE INTERIM FINAL RULE SAID ABOUT SCOPE OF SERVICES AND THEN
WE’LL TALK ABOUT THE CHANGES.>>SURE, PAM.
AS YOU ALL MAY RECALL, THE INTERIM FINAL RULE ESTABLISHED
SIX BROAD CLASSIFICATIONS OF BENEFITS.
INPATIENT IN NETWORK, INPATIENT OUT OF NETWORK, OUTPATIENT IN
NETWORK, OUTPATIENT OUT OF NETWORK, EMERGENCY ROOM CARE AND
PRESCRIPTION MEDICATION. THESE CLASSIFICATIONS WERE SET
UP TO HELP FACILITATE THE APPLICATION OF THE PARITY
REQUIREMENTS SO THAT COMPARABLE MENTAL HEALTH AND SUBSTANCE USE
DISORDER TREATMENT BENEFITS WOULD BE COMPARED TO
MEDICAL/SURGICAL BENEFITS SO YOU COMPARE INPATIENT TO INPATIENT,
OUTPATIENT TO OUTPATIENT, ET CETERA.
THE IFR ALSO ESTABLISHED THAT IF A PLANNER ISSUER PROVIDES
COVERAGE IN ANY ONE OF THOSE CLASSIFICATIONS, THEY MUST ALSO
PROVIDE MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS
IN EVERY OTHER CLASSIFICATION FOR WHICH THERE ARE
MEDICAL/SURGICAL BENEFITS. THE IFR DID NOT DEFINE THESE
BENEFIT CLASSIFICATIONS, AND IT DID NOT SPECIFY HOW THE SERVICES
SHOULD BE CATEGORIZED WITHIN THEM, BUT IT DID REQUIRE THE
PLANS DEFINE THOSE TERMS, THE CLASSIFICATIONS UNIFORMLY
BETWEEN MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS
AND MEDICAL/SURGICAL, AND ALSO REQUIRE THAT PLANS AND ISSUERS
ASSIGN MENTAL HEALTH AND SUBSTANCE — TO THESE
CLASSIFICATIONS IN A CONSISTENT MANNER, AND WE ARE CARRYING OVER
THOSE REQUIREMENTS IN THE FINAL RULE.
>>SO KIRSTEN, SOME OF THE BEHAVIORAL HEALTH BENEFITS DON’T
EASILY FIT INTO THAT INPATIENT/OUTPATIENT SORT OF
CATEGORY, SO AN EXAMPLE MIGHT BE PARTIAL HOSPITALIZATION, SO CAN
YOU TELL US A LITTLE BIT ABOUT HOW THE FINAL RULE ADDRESSES
THAT ISSUE?>>RIGHT, SO WE GOT A LOT OF
COMMENTS ASKING HOW AN INTERMEDIATE LEVEL OF CARE FIT
INTO THIS FRAMEWORK, AND THE TYPES OF SERVICES THAT WERE
DESCRIBED IN THE COMMENTS INCLUDED THINGS LIKE TIME
LIMITED RESIDENTIAL TREATMENT OR INTENSIVE OUTPATIENT PARTIAL
HOSPITALIZATION, THINGS THAT ARE REHABILITATIVE IN NATURE AND
MORE INTENSIVE THAN OUTPATIENT OFFICE VISITS BUT NOT REQUIRING
HOSPITALIZATION FOR AN ACUTE CONDITION.
WE STUDIED THIS ISSUE CLOSELY, WE LOOKED AT HOW PLANS GENERALLY
COVER THIS LEVEL OF CARE. WE FOUND OUT MOST PLANS DO, IN
FACT, COVER THESE TYPES OF SERVICES, MOST LARGE GROUP
PLANS, I SHOULD CLARIFY, AND THAT THEY ALSO COVER COMPARABLE
SERVICES ON THE MEDICAL SIDE, THINGS LIKE SKILLED NURSING
FACILITY CARE OR HOME HEALTHCARE, SO THE FINAL RULE
CLARIFIES THAT THE PRINCIPLES OF PATIENTS DO APPLY TO THESE TYPES
OF INTERMEDIATE SERVICES AND THE BEHAVIORAL HEALTH INTERMEDIATE
SERVICES AND GENERAL HEALTH INTERMEDIATE SERVICES SHOULD BE
CLASSIFIED IN THE INPATIENT CATEGORY OR OUTPATIENT CATEGORY
IN A CONSISTENT MANNER. FOR EXAMPLE, IF A PLAN
CLASSIFIES CARE IN A SKILLED NURSING FACILITY OR A REHAB
HOSPITAL AS AN INPATIENT BENEFIT, THEN IF THEY COVER
RESIDENTIAL TREATMENT, THEY SHOULD ALSO — FOR MENTAL HEALTH
OR SUBSTANCE ABUSE, THEY SHOULD ALSO LIKEWISE TREAT THOSE FOR
PURPOSES OF PARITY ANALYSIS. THE FINAL RULE ALSO CLARIFIES
THAT THE NON-QUANTITATIVE TREATMENT LIMIT REQUIREMENTS
APPLY TO PLAN EXCLUSIONS THAT AFFECT THE SCOPE OF SERVICES IN
THIS AREA, RESTRICTIONS BASED ON GEOGRAPHIC LOCATION, FACILITY
TYPE, PROVIDER SPECIALTY, AND OTHER CRITERIA HAVE TO BE
APPLIED IN A COMPARABLE MANNER TO MENTAL HEALTH AND SUBSTANCE
ABUSE AS THEY APPLY TO MEDICAL AND SURGICAL.
WHAT THIS MEANS FOR EXAMPLE IS A PLANNER/ISSUER CANNOT EXCLUDE
SUBSTANCE USE IN ANY SETTING OUTSIDE A HOSPITAL UNLESS THEY
HAVE A SIMILAR LIMITATION ON THE MEDICAL SIDE.
>>THANK YOU, KIRSTEN. SO THERE ARE SOME EXAMPLES IN
THE FINAL RULE THAT MIGHT BE HELPFUL AS PEOPLE LOOK AT IT, SO
AMY, THERE’S ANOTHER AREA OF THE FINAL RULE THAT RELATES TO THE
REQUIREMENTS FOR PLANS TO DISCLOSE CERTAIN TYPES OF
INFORMATION. I KNOW THIS HAS BEEN VERY
IMPORTANT TO BENEFICIARIES. CAN YOU DESCRIBE WHAT THE FINAL
RULE LAYS OUT ABOUT DISCLOSURE?>>SURE, ABSOLUTELY, PAM.
THE STATUTE, I THINK, WAS VERY CLEAR THAT THE CRITERIA FOR
MEDICAL NECESSITY DETERMINATIONS WITH RESPECT TO MENTAL HEALTH
AND SUBSTANCE USE DISORDERS HAD TO BE DISCLOSED TO CONSUMERS, AS
WELL AS THE REASONS FOR ANY DENIAL.
BUT WHAT WE HEARD IN THE COMMENT LETTERS AFTER THE INTERIM FINAL
WAS THERE MIGHT HAVE BEEN SOME CONFUSION ABOUT CONSUMERS’
ACCESS TO INFORMATION ON THE MED/SURG SIDE, BECAUSE REMEMBER,
MHPAEA REQUIRES CLARITY. WHAT WE CLARIFIED IN THE FINAL
RULES IS THAT PLANS AND ISSUERS, NOT ONLY DO THEY HAVE TO COMPLY
WITH THE MHPAEA BUT ALSO ALL THE OTHERS OF APPLICABLE LAW.
UNDER ERISA, WE CLARIFY FOR EVERYONE THAT ERISA PLANS ARE
MOST OF YOUR PRIVATE SECTOR EMPLOYMENT BASED HEALTH PLANS,
THOSE PLANS HAVE TO MAKE AVAILABLE TO CONSUMERS UPON
REQUEST ALL THE INSTRUMENTS UNDER WHICH THE PLAN IS
ESTABLISHED AND OPERATED. WE SAY THAT INCLUDES DOCUMENTS
WITH INFORMATION ON MEDICAL NECESSITY CRITERIA FOR BOTH
MEDICAL/SURGICAL BENEFITS AND MENTAL HEALTH SUBSTANCE USE
DISORDER BENEFITS, AS WELL AS ALL THE PROCESSES, STRATEGIES
AND EVIDENTIARY STANDARDS AND OTHER FACTORS THAT PLANS USE
TO APPLY NQTLS WITH RESPECT TO BOTH MENTAL HEALTH SUBSTANCE USE
AND MEDICAL. UNDER THE DEPARTMENT OF LABOR
CLAIMS PROCEDURE REGULATION AND THE AFFORDABLE CARE ACT, THAT
APPLIES TO BOTH YOUR PRIVATE SECTOR EMPLOYMENT BASED PLANS
BUT ALSO NEW INDIVIDUAL MARKET POLICIES BOTH INSIDE AND OUTSIDE
THE EXCHANGES CLAIMANTS, PROVIDERS ACTING ON THEIR BEHALF
IN AN APPEAL SITUATION ARE ENTITLED TO FREE OF CHARGE
REASONABLE ACCESS TO AND COPIES OF ALL DOCUMENTS, RECORDS, AND
OTHER INFORMATION RELEVANT TO A CLAIM.
IN ADDITION TO PUTTING OUT THE FINAL RULES, WE ALSO PUT OUT
SOME FAQS, FREQUENTLY ASKED QUESTIONS, WHERE THE DEPARTMENTS
OF LABOR AND HHS SAY EVEN WITH THESE IMPORTANT DISCLOSURE
REQUIREMENTS UNDER BE EXISTING LAW, WE STILL REMAIN FOCUSED ON
TRANSPARENCY AND WHETHER INDIVIDUALS HAVE THE NECESSARY
INFORMATION THEY NEED TO COMPARE NQTLS ON THE MEDICAL/SURGICAL
SIDE WITH THE MENTAL HEALTH AND SUBSTANCE USE DISORDER SIDE IN
ORDER TO EFFECTIVELY ENSURE COMPLIANCE WITH MHPAEA.
SO WE REQUEST COMMENTS ON WHAT ADDITIONAL STEPS THE DEPARTMENT
CAN TAKE TO ENSURE COMPLIANCE THROUGH HEALTH PLAN TRANSPARENCY
INCLUDING WHAT OTHER DISCLOSURE REQUIREMENTS WOULD PROVIDE MORE
TRANSPARENCY TO ENROLLEES AND PROVIDERS, PARTICULARLY IN THE
INDIVIDUAL MARKET, AND MAYBE NON-FEDERAL GOVERNMENTAL PLANS
AND CHURCH PLANS THAT MIGHT NOT BE SUBJECT TO THE ERISA RULES.
WE REQUEST COMMENTS BY JANUARY 8TH, 2014.
>>SO AMY, JUST TO CLARIFY, THERE’S OTHER FEDERAL LAWS AT
PLAY HERE IS THE POINT, ERISA IS ANOTHER FEDERAL LAW, FEDERAL
REGULATIONS, SO WE’RE NOT ONLY BRINGING THOSE INTO PLAY BUT
ALSO ASKING PEOPLE TO LET US KNOW WHAT ELSE WE COULD DO?
>>EXACTLY, PAM.>>AND BY JANUARY — WHAT WAS
THAT?>>JANUARY 8TH.
>>OKAY, GREAT. SO JIM, LET’S GO BACK TO YOU.
HOW DOES THE RULE INTERSECT WITH THE AFFORDABLE CARE ACT AND
THINGS DETERMINED TO BE ESSENTIAL HEALTH BENEFITS?
>>HHS PUBLISHED A FINAL RULE ON ESSENTIAL HEALTH BENEFITS THAT
REQUIRES ISSUERS OF NON-GRANDFATHERED PLANS AND
INDIVIDUAL AND SMALL GROUP MARKETS TO ENSURE THAT SUCH
PLANS PROVIDE ALL CATEGORIES THAT REQUIRE SUCH PLANS TO
PROVIDE ALL CATEGORIES OF ESSENTIAL HEALTH BENEFITS
INCLUDING MENTAL HEALTH AND SUBSTANCE USE BENEFITS.
FURTHERMORE, THE EHB RULE REQUIRES ISSUERS PROVIDING THE
BENEFITS THROUGH ESSENTIAL HEALTH BENEFIT TO PROVIDE THOSE
BENEFITS IN COMPLIANCE WITH THE MHPAEA REGULATIONS.
EVEN WHEN THOSE REQUIREMENTS WOULD NOT OTHERWISE APPLY.
SO ACCORDINGLY, ALL INSURED NON-GRANDFATHERED INDIVIDUAL
HEALTH INSURANCE COVERAGE MUST PROVIDE MENTAL HEALTH AND
SUBSTANCE USE BENEFITS IN COMPLIANCE WITH MHPAEA, AND ALSO
ALL NON-GRANDFATHERED SMALL GROUP PLANS MUST PROVIDE MENTAL
HEALTH SUBSTANCE USE DISORDER BENEFITS IN COMPLIANCE WITH MHPAEA,
REGARDLESS OF MHPAEA’S SMALL EMPLOYER —
>>SO THIS IS ANOTHER AREA WHERE FEDERAL LAWS ARE INTERPLAYING
AND MUST BE LOOKED AT TOGETHER. AND THAT’S EXPLAINED, I THINK,
IN THE LAW HERE — IN THE NEW REG, SO IT’S GOOD.
SO JIM, ALSO I UNDERSTAND THAT IN ADDITION TO THE REGULATION,
ACTUALLY KIRSTEN, I THINK THIS MAY BE A GOOD QUESTION FOR YOU,
IN ADDITION TO THE REGULATION, AND THE FREQUENTLY ASKED
QUESTIONS DOCUMENT THAT WAS MENTIONED, THE ASSISTANT
SECRETARY FOR PLANNING AND EVALUATION HAS RELEASED A STUDY
THAT SAYS A LITTLE BIT ABOUT WHAT WE FOUND PLANS ARE DOING SO
FAR ABOUT MHPAEA OR ABOUT THESE ISSUES.
CAN YOU TALK ABOUT THAT?>>SURE.
WE HAVE A STUDY THAT WE’RE ISSUING TODAY WHERE WE HAD A
COUPLE LARGE RESEARCH FIRMS AND A COUPLE BENEFITS CONSULTING
FIRMS HELP US OUT AND TAKE A LOOK AT HOW PLANS HAVE RESPONDED
TO MHPAEA OVER THE PAST COUPLE YEARS, AND WE FOUND THAT MOST
LARGE GROUP PLANS HAVE MADE REALLY SUBSTANTIAL IMPROVEMENTS
IN THEIR COVERAGE IN RESPONSE TO MHPAEA BY LOWERING FINANCIAL
REQUIREMENTS AND ELIMINATING VISIT LIMITS AND LIMITS ON
INPATIENT DAYS COVERED. WE LOOKED A LITTLE BIT AT THE
NON-QUANTITATIVE TREATMENT LIMITS, THAT WAS NOT A FOCUS OF
THE STUDY, THERE IS A LITTLE BIT OF INFORMATION THERE ON HOW
PLANS USE NQTLS, AND WE ARE GOING TO CONTINUE TO STUDY THAT
AREA AND OTHER ASPECTS OF PARITY IN THE YEARS TO COME.
>>GREAT. SO WE HAVE A LITTLE BIT OF
INFORMATION ALREADY, THEN WE’LL BE FOLLOWING AS WELL AS THIS NEW
FINAL RULE GETS INTO PLAY. SO I WANT TO THANK AMY AND
KIRSTEN AND JIM. WE’LL BE HEARING MORE FROM THEM
BECAUSE WE’RE GOING TO TURN TO OUR LISTENERS FOR QUESTIONS.
I WANT TO JUST SUMMARIZE THAT THERE’S PRESS RELEASE AVAILABLE,
THERE IS THE FREQUENTLY ASKED QUESTIONS THAT WERE MENTIONED
AVAILABLE, THE REGULATION ITSELF IS POSTED TODAY AND I BELIEVE,
AMY, YOU HAD A COMMENT EARLIER IN ANOTHER MEETING THAT IT WILL
BE AVAILABLE IN HARD COPY. DO YOU WANT TO COMMENT ON THAT?
>>RIGHT. IT’S ON THE PUBLIC DISPLAY PAGE
OF THE FEDERAL REGISTER TODAY, WHICH YOU CAN ACCESS FROM EITHER
THE DEPARTMENT OF LABOR OR THE HHS WEBSITE.
IT WILL ACTUALLY BE PUBLISHED IN THE FEDERAL REGISTER IN PRINTED
FORM ON NOVEMBER 13TH.>>GREAT.
SO YOU CAN GET IT ELECTRONICALLY OR IN A LITTLE BIT BY HARD COPY.
AND THEN THE ASPE REPORT IS AVAILABLE AS WELL ON THEIR
WEBSITE, I PRESUME. SO WE ALSO WANT TO TELL YOU THAT
ADDITIONAL MATERIALS ARE BEING DEVELOPED.
THERE IS, AS WE’VE SAID, THE FREQUENTLY ASKED QUESTIONS
DOCUMENT TODAY, BUT WE’RE GOING TO BE DEVELOPING ADDITIONAL
MATERIALS AND THEY’LL BE POSTED SHORTLY.
WE’RE ALSO GOING TO BE DOING SOME REGIONAL DISCUSSIONS OUT
THERE, SO YOU WILL GET MORE INFORMATION ABOUT THAT FROM
EITHER SAMHSA’S REGIONAL ADMINISTRATORS OR SOME OF THE
OTHER HHS AND OUR PARTNER AGENCIES REGIONAL FOLKS, AND
WE’LL BE SETTING UP THOSE OPPORTUNITIES FOR PEOPLE TO HAVE
SOME DISCUSSION ABOUT WHAT DOES THIS MEAN.
THIS LAW IS A TREMENDOUS ACHIEVEMENT FOR ENSURING EQUAL
ACCESS TO HEALTHCARE, AND I REALLY WANT TO THANK ALL OF THE
COLLEAGUES WHO HAVE BEEN DOING SO MUCH WORK ON THIS AND ALSO
FOR THE WORK OF THE BEHAVIORAL HEALTH COMMUNITY.
I ENCOURAGE YOU TO LEARN MORE ABOUT THIS BY VISITING TREASURY
LABOR AND HHS, SPECIFICALLY, I THINK THE CMS WEBSITE MAY BE THE
BEST PLACE TO GO WITHIN HHS FOR THIS AND VIEWING SOME OF THE
MATERIALS THAT WE’VE PROVIDED YOU, YOU’LL BE ABLE TO GET TO
SOME OF THOSE MATERIALS ON SAMHSA’S WEBSITE BY LINKS.
SO CONTINUE TO FOCUS EFFORTS ON IMPROVING THE LIVES OF PEOPLE
WITH BEHAVIORAL HEALTH CONDITIONS, THIS IS ONE MAJOR
STEP FORWARD. SO WE WANT TO OPEN IT NOW,
OPERATOR, TO QUESTION FROM THOSE WHO ARE LISTENING.
OPERATOR, DO WE HAVE — CAN YOU LET US KNOW HOW WE WOULD DO
THAT?>>OPERATOR: THANK YOU.
AT THIS TIME IF YOU’D LIKE TO ASK A QUESTION, PLEASE PRESS
“*1”. YOU WILL BE PROMPTED TO RECORD
YOUR NAME. IF YOU’D LIKE TO WITHDRAW YOUR
REQUEST, YOU MAY PRESS “*2”. ONCE AGAIN, TO ASK A QUESTION,
PLEASE PRESS “*1”. ONE MOMENT, PLEASE.
OUR FIRST QUESTION COMES FROM ROBERT LINDSAY.
PLEASE STATE YOUR COMPANY NAME.>>BOB LINDSAY, PRESIDENT AND
CEO OF THE NATIONAL COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE.
PAM AND EVERYONE ELSE, I WANT TO JUST SAY THANK YOU FOR THIS
HISTORIC DAY AS YOU INDICATED. WE ARE THRILLED TO SEE THE FINAL
REGULATIONS COME OUT. IF YOU COULD TALK JUST A MINUTE
A LITTLE BIT ABOUT THE PLANS AROUND ENFORCEMENT OF MANY OF
THE PROVISIONS WITHIN THE REGULATIONS, THAT WOULD BE VERY
HELPFUL.>>THANKS, ROBERT.
WE HAD A FEELING THIS MIGHT COME UP.
I THINK WE’LL START WITH AMY AND THEN IF OTHERS WANT TO JOIN IN
THE CONVERSATION ABOUT COMPLIANCE OR ENFORCEMENT.
>>SURE THIS, IS AMY TURNER FROM THE LABOR DEPARTMENT.
OF COURSE ALL THE DEPARTMENTS UNDERSTAND THAT ENFORCEMENT IS
KEY TO ENSURING THAT CONSUMERS GET WHAT THEY’RE ENTITLED TO
UNDER THE LAW. ONE OF THE FAQS THAT WE PUT
OUT REMINDS FOLKS IF THEY HAVE A QUESTION REGARDING COMPLIANCE OR
IF THEY HAVE A COMPLAINT, HOW THEY CAN CONTACT EITHER THE
LABOR DEPARTMENT OR THE DEPARTMENT OF HHS.
WHAT WE REMIND FOLKS IS THAT REGARDLESS OF WHICH NUMBER YOU
CALL, IT DOESN’T MATTER, THE FEDERAL DEPARTMENTS WILL
COORDINATE AMONGST EACH OTHER AND WE’LL ALSO WORK TOGETHER
WITH THE STATES AS NECESSARY TO ENSURE THAT ANY MHPAEA
VIOLATIONS ARE ADDRESSED. SO FOR CONSUMERS, WE TRY TO MAKE
IT EASY, YOU DON’T NEED TO KNOW WHETHER YOUR PLAN IS SUBJECT TO
ERISA AND THE LABOR DEPARTMENT RULES OR WHETHER IT’S SUBJECT TO
HHS RULES OR WHETHER IT’S THE STATE.
THERE ARE TWO NUMBERS IN THERE CONSUMERS CAN CONTACT EITHER
ONE, AND THE DEPARTMENTS WILL WORK TOGETHER BEHIND THE SCENES
AND WITH THE STATES AS APPROPRIATE TO MAKE SURE THAT
ANY VIOLATIONS ARE CORRECTED.>>SO BOB, IN THE FAQS, MORE
INFORMATION.>>VERY GOOD.
THANK YOU.>>DID YOU WANT TO ADD ANYTHING,
JIM?>>NO, I’M FINE.
>>ALL RIGHT, GREAT. THANK YOU.
WHAT’S THE NEXT QUESTION, OPERATOR?>>OPERATOR: AND ONCE AGAIN, AS
A REMINDER, IF YOU’D LIKE TO ASK A QUESTION, PLEASE PRESS “*1”.
ONE MOMENT, PLEASE. OUR NEXT QUESTION COMES FROM
DEBBIE PLOTNICK. PLEASE STATE YOUR COMPANY NAME.
>>THIS IS DEBBIE PLOTNICK FROM MENTAL HEALTH AMERICA.
THANK YOU VERY MUCH, I’M ACTUALLY AT THE CARTER CENTER
WHERE SECRETARY SEBELIUS ANNOUNCED THE REGS COMING OUT
TODAY. WE’RE ALL VERY EXCITED.
BUT MY QUESTION HAS TO DO WITH WHAT PLANS ARE IN PLACE FOR THE
PLACES WHERE PARITY IS NOT YET GOING TO BE?
SPECIFICALLY WITH THE EXPANSION OF MEDICAID IN THE STATES?
>>DEBBIE, THANK YOU FOR THE QUESTION.
MEDICAID ACTUALLY RELEASED A STATE HEALTH OFFICIAL LETTER IN
JANUARY OF 2013, SORT OF DESCRIBING WHAT ROLES PARITY
PLAYS IN THAT PROGRAM AT THIS POINT.
AS YOU KNOW, THE LAW APPLIES A LITTLE DIFFERENTLY TO MEDICAID
AND THERE ARE PARTS OF IT, BECAUSE IT IS EXPANDED, BECAUSE
OF THE ACA, THAT IT DOES APPLY, BUT THAT LETTER PROVIDES SOME
DIRECTION ABOUT THAT. IF YOU NEED A COPY OF THAT
LETTER, IT’S ON THE CMS WEBSITE. I THINK MEDICAID — ONCE THIS
REG IS OUT, MEDICAID OR CMS IS ALSO GOING TO BE LOOKING AT
REGULATIONS AROUND THIS THAT WOULD APPLY DIRECTLY TO
MEDICAID. SO MORE TO COME.
>>VERY GOOD, THANK YOU.>>JIM, DID YOU WANT TO SAY ANY
MORE THAN THAT?>>IN THE PREAMBLE TO THE FINAL
RULE, WE DO REMIND PEOPLE THAT THE FINAL REGULATIONS DO NOT
APPLY TO MEDICAID OR CHP PLANS, BUT CMS WILL BE ISSUING GUIDANCE
IN THE FUTURE ON THOSE SUBJECT MATTERS.
>>OKAY. NEXT QUESTION, OPERATOR?
>>OPERATOR: I SHOW NO FURTHER QUESTIONS.
ONCE AGAIN, IF YOU’D LIKE TO ASK A QUESTION, PLEASE PRESS “*1”.
ONE MOMENT, PLEASE. YOU HAVE A QUESTION FROM BILL
LEITCH. PLEASE STATE YOUR COMPANY NAME.
>>HI, THANK YOU. MY COMPANY NAME IS THE
CUMBERLAND HEIGHTS FOUNDATION IN NASHVILLE, TENNESSEE.
MY QUESTION HAS TO DO WITH THE EVIDENTIARY STANDARDS THAT WILL
BE REQUIRED FROM INSURANCE COMPANIES TO SHOW THAT THEY ARE
PROVIDING EQUAL ACCESS TO SUBSTANCE USE DISORDERS AS THEY
ARE MENTAL AND HEALTH CONDITIONS, AND SECONDLY, DO WE
HAVE ANY KIND OF WHISTLE BLOWER PROTECTION OR CONFIDENTIALITY
PROTECTION IN REPORTING THESE OBSERVATIONS?
>>SO BILL, I THINK YOU’RE ASKING TWO QUESTIONS, AND I JUST
WANT TO MAKE SURE I UNDERSTAND THE FIRST ONE.
YOU’RE ASKING WHAT IS THE COMPARABILITY BETWEEN SUBSTANCE
ABUSE AND MENTAL HEALTH?>>WELL, I’M SPECIFICALLY ASKING
ABOUT ACCESS TO MENTAL HEALTH CONDITIONS VERSUS SUBSTANCE USE
DISORDER CONDITIONS. AND HOW WE PROVE OR ENFORCE
PARITY ACROSS THE BOARD.>>I THINK — THIS IS AMY
TALKING.>>THIS IS AMY TURNER FROM THE
LABOR DEPARTMENT.>>I THINK A LOT OF FIGURING
THAT OUT IS GOING TO BE A FACTS AND CIRCUMSTANCES ANALYSIS, BUT
WE DID MAKE CLEAR THAT THE NON-QUANTITATIVE TREATMENT
LIMITATIONS ARE NOT JUST MEDICAL MANAGEMENT TECHNIQUES.
IT ALSO INCLUDES RULES THAT PLANS MAY HAVE FOR PROVIDER
ACCESS TO A NETWORK, INCLUDING REIMBURSEMENT RATES.
SO THAT WOULD BE WITHIN THE SCOPE OF THE NQTLS, IT WOULD
BE REQUIRED TO BE IN PARITY, THE PLANS AND ISSUERS COULD BE NO
MORE STRINGENT ON THE MENTAL HEALTH AND SUBSTANCE USE
DISORDER SIDE THAN THEY ARE ON THE MEDICAL/SURGICAL SIDE.
SO THE PARITY REQUIREMENTS DO APPLY AND I THINK ASSESSING THEM
WITH RESPECT TO ANY PARTICULAR PLAN WOULD BE DONE ON A FACTS
AND CIRCUMSTANCES BASIS.>>I SEE.
>>ON YOUR SECOND QUESTION, WHICH WAS ABOUT —
>>BILL, YOU HAD A SECOND QUESTION.
MY HEAD WAS GOING AROUND ON YOUR FIRST QUESTION.
YOUR SECOND ONE WAS?>>IT REALLY HAS TO DO WITH THE
CONFIDENTIALITY OF REPORTING.>>WHISTLEBLOWER.
OKAY.>>WE UNDERSTAND THIS HAPPENS IN
THE CONTEXT OF MHPAEA WITH ALL SORTS OF CLAIMS.
CERTAINLY AT THE LABOR DEPARTMENT, WE HAVE A TOLL-FREE
NUMBER, INDIVIDUALS CALL. THEY’RE AFRAID TO MAYBE SPEAK UP
AND ASK A QUESTION ABOUT THEIR EMPLOYER.
>>RIGHT.>>INDIVIDUALS CAN CONTACT US.
WE CAN FOLLOW UP WITHOUT HAVING — IDENTIFYING THE NAME
OF THE INDIVIDUAL. THE LABOR DEPARTMENT DOES DO
DIRECT ENFORCEMENT. THIS LAW IS NOT ENFORCED ONLY
THROUGH PRIVATE CAUSES OF ACTION, SO I WOULD SAY IF AN
INDIVIDUAL DOES HAVE A QUESTION OR A COMPLAINT, TO FEEL FREE TO
CONTACT THE LABOR DEPARTMENT AND WE CAN INVESTIGATE IT ON THE
INDIVIDUAL’S BEHALF, PARTICULARLY IF THEY WANT TO
KEEP THEIR IDENTITY PRIVATE.>>AND BY INDIVIDUALS, YOU ARE
INCLUDING PROVIDERS, HEALTHCARE PROVIDERS?
>>ABSOLUTELY.>>ALL RIGHT.
THANK YOU.>>BILL, I DON’T WANT TO OPEN A
QUESTION YOU WEREN’T TRYING TO OPEN BUT I DO WANT TO BE CLEAR
THAT WE’RE TALKING ABOUT THE — ON YOUR FIRST QUESTION, ABOUT
THE RELATIONSHIP OR THE COMPARABILITY BETWEEN MENTAL
HEALTH AND SUBSTANCE ABUSE TO MED/SURG, MEDICAL AND SURGICAL
BENEFITS, NOT NECESSARILY THE COMPARABILITY BETWEEN SUBSTANCE
ABUSE AND MENTAL HEALTH. SO THAT IS A BIGGER ISSUE, AN
IMPORTANT ISSUE, BUT THAT’S A LITTLE DIFFERENT THAN WHAT THIS
REG IS MEANT TO DEAL WITH.>>THAT’S CORRECT.
AND WHAT I WAS REALLY ASKING ABOUT, BASICALLY, IS THE BURDEN
OF PROOF. WHAT DOES THE INSURANCE PLAN
HAVE TO COME UP WITH TO SHOW THAT THEY ARE PROVIDING EQUAL
ACCESS TO SUBSTANCE USE DISORDER.
THAT WAS THE REAL QUESTION. AND I THINK THAT’S A
CASE-BY-CASE BASIS.>>OKAY.
GREAT.>>THANK YOU.
>>WHAT’S THE NEXT QUESTION, OPERATOR?>>OPERATOR: YOUR NEXT QUESTION
COMES FROM MARTIN SWANSON. PLEASE STATE YOUR COMPANY NAME.
>>MARTIN SWANSON, NEBRASKA DEPARTMENT OF INSURANCE.
TWO QUESTIONS. FIRST QUESTION, SINCE POLICIES
FILED WITH OUR DEPARTMENT THAT WERE PLACED ON THE FEDERALLY
FACILITATED MARKETPLACE CAN ONLY BE FILED ONCE PER YEAR FOR
THE — RATES, DOES THIS REGULATION CAUSE CHANGES TO
THOSE PARTICULAR FORMS AND WILL A COMPANY BE ALLOWED TO CHANGE
RATE DUE TO THIS REGULATION BEING ISSUED NOW?
>>DO YOU WANT TO TAKE THAT ONE, AMY?
>>CAN YOU REPEAT THE QUESTION?>>YEAH.
THE QUESTION WAS INDIVIDUALS FROM THE NEBRASKA DEPARTMENT OF
INSURANCE, I BELIEVE, IF I GOT THAT RIGHT?
>>THAT’S CORRECT.>>THE QUESTION WAS, SINCE PLANS
FILE THEIR RATES AND PLANS ONCE A YEAR, DOES THIS CHANGE THEIR
RATES IN THE MIDDLE OF A YEAR, OR CAN THEY CHANGE THEIR RATES
IN THE MIDDLE OF A YEAR.>>OBVIOUSLY THE FREQUENCY OF
LATE FILINGS AND SO FORTH IS COVERED BY STATE LAW, BUT IN IT
TERMS OF THE PLANS IN THE MARKETPLACE, THE QAPS, WE
ISSUED THE ESSENTIAL HEALTH BENEFITS REGULATION BACK IN
FEBRUARY OF 2013, SO — AND WE MADE CLEAR IN THOSE REGULATIONS
THAT THE PLAN IN THE MARKETPLACE WOULD HAVE TO COVER MENTAL
HEALTH AND SUBSTANCE USE BENEFITS IN PARITY IN COMPLIANCE
WITH THE PARITY LAW. SO IN TERMS OF THE PLANS IN THE
MARKET PLACE, AND ALSO OTHER SMALL GROUP HEALTH PLANS, I
THINK THAT PARTICULARLY NON-GRANDFATHERED SMALL GROUP
HEALTH PLANS, THEY HAVE ALREADY FACTORED IN THIS MHPAEA
COMPLIANCE INTO THEIR RATES. SO THERE SHOULDN’T BE TOO MUCH
CHANGE IN THE MIDDLE OF THE YEAR 2014, IN CONSIDERING THESE FINAL
RULES.>>SO AMY, THE EFFECTIVE DATE
MIGHT BE HELPFUL.>>WE SHOULD POINT OUT, I’M NOT
SURE THAT WE DID AT THE BEGINNING, ANY CLARIFICATIONS IN
THE FINAL RULE, THEY ARE EFFECTIVE FOR PLAN YEARS
BEGINNING ON OR AFTER JULY 1ST, 2014, SO FOR EXAMPLE, IF YOU’RE
A CALENDAR YEAR PLAN IN THE MARKETPLACE, CALENDAR YEAR ERISA
PLANS, THE CLARIFICATION IN THE FINAL RULES WILL BEGIN TO APPLY
ON JANUARY 1ST, 2015.>>THAT’S HELPFUL.
THANK YOU.>>THANK YOU.
OKAY. OTHER QUESTIONS, OPERATOR?>>OPERATOR: YOUR NEXT QUESTION
COMES FROM JOE PARKS. PLEASE STATE YOUR COMPANY NAME.
>>THIS IS JOE PARKS FROM MISSOURI DEPARTMENT OF MENTAL
HEALTH. IS THERE GUIDANCE IN THE RULE OR
FROM ANY OF THE AGENCIES REGARDING HOW EITHER
QUANTITATIVE OR QUALITATIVE PARITY APPLIES TO NETWORK
ADEQUACY, THE NUMBER OF PROVIDERS AVAILABLE A PERSON CAN
CHOOSE FROM AND THE DISTANCE THAT THE PATIENT HAS TO TRAVEL
TO GET TO THE PROVIDER?>>THANKS FOR THE QUESTION, JOE.
WHICH ONE OF YOU WANT TO TAKE THAT?
DO YOU WANT TO TAKE THAT, AMY?>>I THINK THIS IS SIMILAR TO A
QUESTION WE HEARD BEFORE. I THINK THE BEST WE COULD SAY AS
FAR AS JUST GENERALIZED GUIDANCE IS THAT ONE OF THE
NON-QUANTITATIVE TREATMENT LIMITATIONS IS STANDARDS FOR
ADMISSION OF PROVIDERS TO NETWORKS, INCLUDING BUT NOT
LIMITED TO REIMBURSEMENT RATES. SO IT IS SUBJECT TO THE PARITY
ANALYSIS, I THINK HOW IT’S GOING TO SHAKE OUT IN ANY PARTICULAR
PLAN OR POLICY, WE WOULD NEED TO LOOK AT ON A CASE-BY-CASE BASIS
TO MAKE SURE THOSE STANDARDS WERE COMPARABLE BETWEEN THE
MENTAL USE AND — AS OPPOSED TO THE MEDICAL/SURGICAL SIDE.
>>OKAY, THANKS. SOME OF THIS MAY BE A LITTLE
BIT — IT MIGHT BE A LITTLE BIT CLEARER WHEN PEOPLE HAVE A
CHANCE ALSO TO JUST LOOK AT WHAT THE CLARIFICATIONS AND THE
EXAMPLES AND STUFF THAT WERE GIVEN IN THE NEW REG, AND I KNOW
WE’RE DOING THIS BEFORE PEOPLE HAVE REALLY HAD A CHANCE TO
DELVE THROUGH ALL OF THAT, BUT THAT’S PART OF THE REASON FOR
THE REGIONAL MEETINGS THAT WE HAVE COMING UP AS WELL.
YOU WILL HAVE READ EVERY WORD BY THEN, I’M SURE.
NEXT QUESTION, OPERATOR.>>OPERATOR: THANK YOU.
OUR LAST QUESTION COMES FROM RANDY THOMPSON.
PLEASE STATE YOUR COMPANY NAME.>>HI, IT’S RANDY THOMPSON FROM
THE NEW JERSEY ASSOCIATION OF MENTAL HEALTH AND ADDICTION
AGENCIES. I JUST WANTED TO ASK A
CLARIFYING QUESTION AS TO WHETHER OR NOT THE FINAL PARITY
RULE WILL AFFECT THE MEDICAID IMD EXCLUSION AT ALL.
>>CAN YOU SAY THE LAST PART AGAIN?
WHETHER OR NOT THE RULE WILL AFFECT WHAT?
>>THE IMD EXCLUSION.>>MEDICAID IMD.
DO YOU WANT TO TAKE THAT? JIM?
>>YES. THE RULES TECHNICALLY DO NOT
APPLY TO MEDICAID IMDS, BUT LIKE IT WAS STATED IN THE PREAMBLE,
CMS WILL BE ISSUING GUIDANCE IN THE FUTURE ON THE MEDICAID AND
CHP PLANS.>>DOES THAT HELP?
>>YES. THANK YOU.
>>OKAY. NEXT QUESTION?>>OPERATOR: THERE ARE NO
FURTHER QUESTIONS. THANK YOU.
>>ALL RIGHT. GREAT.
WELL, THANK YOU, EVERYBODY, WHO WAS ON THE LINE AND WE’LL FIND
OUT FROM THE OPERATOR HOW MANY PEOPLE LISTENED IN TODAY AND WE
LOOK FORWARD TO FURTHER CONVERSATIONS ABOUT THIS AND
THIS HISTORIC NEXT STEP FOR THE BEHAVIORAL HEALTH FIELD.
SO THANK YOU VERY MUCH TO OUR COLLEAGUES FROM LABOR AND FROM
OBVIOUSLY CMS AND ASPE AND SAMHSA APPRECIATES ALL OF YOUR
WORK. THANK YOU.

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