Editor’s Note: In the article below, Manatt Health discusses the key policies in the “Mental Health Parity Improvements Act,” the latest draft legislation from the Senate Finance Committee’s bipartisan mental health initiative. In a recent webinar, Manatt shared a guide to help health plans effectively navigate the complexities of mental health parity. The program explored mental health parity from three interlocking perspectives—litigation, regulatory and legislative—to provide a multifaceted look at its impact on health plans and the patients they serve. To view the free, CLE-eligible webinar on demand and download a free copy of the presentation, click here.
On December 1, the Senate Finance Committee released the fifth and final discussion draft of the Committee’s bipartisan mental health initiative. This discussion draft, released by Chair Ron Wyden (D-OR), Ranking Member Mike Crapo (R-ID), and Committee members Michael Bennet (D-CO) and Richard Burr (R-NC), seeks to address mental health coverage in Medicare and Medicaid. While the Committee describes the draft legislation as the “Mental Health Parity Improvements Act,” several of its provisions do not address “parity” between mental health/substance use disorder benefits and medical/surgical benefits, which is how federal law currently defines mental health “parity.” At 21 pages, the proposal includes five policies, representing a relatively modest set of provisions:
- Clarification of Outpatient Coverage for Medicare Beneficiaries with a SUD. The policy included under the “Medicare Provisions” section would require that Medicare provide guidance to providers “detailing the extent to which partial hospitalization services may be furnished to an individual with a diagnosis of substance use disorder” (SUD) as well as additional information on other forms of Medicare-covered outpatient services for Medicare patients with SUDs.
- Requiring Medicare Advantage (MA) Plans to Maintain Accurate and Updated Provider Directories. The proposal would codify existing regulatory requirements that MA plans maintain accurate provider directories. This section also proposes additional requirements for MA plans to inform CMS in a timely manner (within two days) about changes to a provider’s in-network status and to post plan provider directories on a public website.
- GAO Study Comparing Coverage of Mental Health and SUD Benefits and Non-Mental Health and SUD Benefits. The proposal would require a Government Accountability Office (GAO) study to compare the behavioral health benefits under MA plans to the non-mental health and SUD benefits under MA as well as to the mental health and SUD benefits under original Medicare. The proposal directs GAO specifically to analyze the differences in enrollee cost sharing and utilization management.
- Requiring Accurate and Searchable Provider Directories in Medicaid. This section would codify existing regulations that require Medicaid managed care organizations to maintain “regularly updated” provider directories, including information on whether providers are accepting new patients. The requirements would also be applied to states’ Medicaid fee-for-service programs.
- GAO Report on Disparities in Medicaid Payment Rates for Mental Health and SUD Benefits. Parallel to the MA GAO report, this section would require publication of a GAO report detailing the discrepancies in Medicaid payment rates for mental health and SUD benefits compared with medical and surgical services across a sample of states.
The mandated analyses appear designed to generate information that could inform future, more targeted enforcement initiatives.
The Committee previously released proposals on telehealth policies, youth mental health, the mental health workforce, and integrating physical health and mental health care providers, all of which are summarized in a Finance Committee section-by-section summary. While some of the provisions in the telehealth and pediatric behavioral health discussion drafts were enacted in the Bipartisan Safer Communities Act earlier this year, the path forward for many of the other proposed policies remains unclear as Committee leadership notes their “[intent] to build on” the policies in the “coming months.”
Note: More detailed information on all of the Committee’s proposals is available through Manatt on Health, Manatt’s premium information service. Manatt on Health provides in-depth insights and analyses focused on the legal, policy and market developments that matter to you, keeping you ahead of the trends shaping our evolving health ecosystem. Available by subscription, Manatt on Health delivers a personalized, user-friendly experience that gives you easy access to Manatt Health’s industry-leading thought leadership. To learn more or schedule a demo, contact Barret Jefferds at bjefferds@manatt.com.