ACP Supports Proposed Rule to Ease Access to Behavioral Health and Substance Use Disorder Treatment

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In letter to Department of Labor, ACP says that if implemented properly, the rule will improve access to behavioral health services, improve outcomes

Nov. 3, 2023 (ACP) -- The American College of Physicians strongly supports the U.S. Department of Labor's plans to adjust the implementation of the federal Mental Health Parity and Addiction Equity Act by more clearly ensuring that behavioral health and substance use disorder benefits are no more restrictive than medical and surgical benefits.

In an Oct. 12 letter to Lisa M. Gomez, assistant secretary for the Employee Benefits Security Administration, ACP President Dr. Omar T. Atiq wrote that if implemented properly, the department's proposed regulations “will help improve patient access to behavioral health services, leading to better physical and behavioral health outcomes.”

According to the Centers for Medicare & Medicaid Services, the Mental Health Parity and Addiction Equity Act of 2008 “generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.”

The Department of Labor helps to oversee the enforcement of the law in regard to private group health plans.

“Federal mental health parity laws generally ensure that mental health and substance use disorder benefits are no more restrictive than medical and surgical benefits,” explained Ryan Crowley, ACP senior associate for health policy. “Parity laws don't require plans to offer mental health and substance use disorder services. But if they do, the benefits can't, for example, have higher cost-sharing than comparable medical/surgical benefits.”

The proposed rule “focuses on improving comparative analyses to better understand nonquantitative treatment limits, like prior authorization and other utilization management policies,” Crowley added. “These limits are often harder to enforce than clear-cut differences for something like the number of inpatient days a plan will cover.”

ACP sees the rule as aligning with its strong support of behavioral health parity, “especially as the U.S. grapples with a deep behavioral health crisis where care is often out of reach,” Crowley said.

In the letter, Atiq writes that if the rule is properly enforced, it may help physicians “be better positioned to adopt behavioral health integration approaches like the Collaborative Care Model and Primary Care Behavioral Health Model and swiftly connect patients with the behavioral care they need.”

He added: “As noted in the proposed rule, most primary care visits include a behavioral health component, but physicians often face difficulties linking patients with appropriate specialists. The proposal's attention to achieving parity in network adequacy and composition and fixing ‘ghost’ networks may improve access to psychiatrists and other qualified behavioral health specialists working in physician-led care teams.”

However, Crowley noted that “we're concerned about a few aspects” of the proposed rule, as ACP outlines in the letter. “For one, insurers won't have to submit an analysis of outcomes data if the mental health coverage restriction is based on clinical evidence,” he explained. “It's unclear what criteria insurers will use to justify their policies. Is it free of conflicts? Is the clinical standard peer-reviewed? Or is it developed by an organization affiliated with the insurer?”

Moving forward, Crowley noted that “mental health parity laws are all about ensuring fairness. However, parity can be tough to enforce. If finalized, the proposed rule may make it easier for regulators to determine if plans are violating parity requirements. Regulators often rely on the public to report potential parity violations, so patients, physicians and their staff can help identify and report problems that may be caused by overly restrictive coverage policies.”

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