SUMMARY OF THE WHITE HOUSE PARITY TASK FORCE REPORT AND ACCOMPANYING ACTION ITEMS
On October 27, 2016, the White House Mental Health and Substance Use Disorder Parity Task Force released their recommendations to President Obama. Along with the final report, the Departments issued sub-regulatory guidance in the form of Frequently Asked Questions and Answers (FAQs) and materials to help consumers understand their rights under the Mental Health Parity and Addiction Equity Act (MHPAEA).
The report contained both immediate action steps and long term recommendations, some of which require Congressional action. A summary of the key action steps and recommendations is below.
Immediate Action Items
- Issuance of sub-regulatory guidance in the form of Frequently Asked Questions on Parity and Opioid Use Disorder Treatment, which addresses issues such as the application of parity to opioid treatment access and coverage of court-ordered treatment. See below for full summary of the FAQ.
- Launch of a beta version of a Consumer Web Portal to help drive consumers to the right agency and resources for parity complaints and appeals.
- Release of a Consumer Guide to Disclosure Rights from the Substance Abuse and Mental Health Services Administration (SAMHSA) and Department of Labor. The guide provides a tool to explain the various federal disclosure laws affecting private-sector, employer-sponsored group health plans and insurers.
- Award of grants totaling $9.3 million from the Centers for Medicare and Medicaid Services (CMS) to States to help insurance regulators monitor compliance with the law.
- Announcement that SAMHSA will host two State Policy Acacdemies on Parity Implementation for State Officials in 2017. One will focus on the commercial market and the other on Medicaid and the Children's Health Insurance Program (CHIP).
Ongoing and Future Action Steps
- The Department of Labor (DOL) will release information annually investigation findings and violations cited to inform future policymaking efforts. HHS is encouraged to do the same.
- CMS will add parity compliance to its review of plans subject to the Essential Health Benefit requirements of the Affordable Care Act and expects state regulators to do so as well.
- The Office of Personnel Management (OPM) will review non-quantitative treatment limitations applicable to substance use disorder benefits in the Federal Employees Health Benefits Program and take corrective action as needed.
- CMS will review mental health and addiction benefits offered by Medicare Advantage plans and identify improvements needed to advance parity protections.
- Develop a parity analysis toolkit to help state Medicaid and CHIP agencies assess their programs' compliance with the final rule.
- Eliminate 190-day lifetime limit on inpatient treatment in psychiatric hospitals under Medicare Part A. (Requires Congressional action.)
- Provide federal support to state efforts to enforce parity through trainings, resources and new implementation tools. The Task Force recommended that federal regulators work with the National Association of Insurance Commissioners (NAIC) and states to develop a standardized template that states might use to help assess parity compliance. It also encouraged federal regulators, the NAIC, and other stakeholders to consider a joint effort to develop a model prior authorization form and other model forms.
- Develop additional examples of parity compliance best practices and warning signs of potential non-compliance, including network adequacy issues.
- Increase federal agencies' capacity to audit health plans for parity compliance by including funding for additional staffing resources in agency budgets. (Appropriation of additional funds requires Congressional action.)
- Allow the Department of Labor (DOL) to assess civil monetary penalties for parity violations. (Requires Congressional action.)
- Require non-ERISA plans to disclose processes, strategies, evidentiary standards, and other factors used to apply limitations to medical and surgical services to allow for a parity evaluation. (Requires Congressional action.)
- Eliminate the parity opt-out option for self-funded non-federal government health plans. (Requires Congressional action.)
Summary of the FAQ on Parity and Opioid Use Disorder Treatment
On October 27, 2016, DOL, HHS and the Department of Treasury issued guidance in the form of Frequently Asked Questions (FAQ) on parity and opioid use disorder treatment. The FAQ clarify that:
- A plan cannot have a “fail-first” requirement that applies to MH/SUD benefits that includes a condition the beneficiary cannot reasonably satisfy due to lack of access, and the lack of access to programs exists only with respect to the required MH/SUD services (for example, no providers available within a geographic area). Because the Departments' prior guidance did not address the application of fail-first requirements in situations involving lack of access and may have reasonably been interpreted in an alternative manner, the Departments will apply this clarifying guidance for plan years beginning on or after March 1, 2017 (FAQ 5).
- Medication Assisted Treatment (MAT) - the use of medication in combination with behavioral health services to treat substance use disorders, including opioid use disorder - is a "substance use disorder benefit" as defined by the law and thus parity protections apply.
A plan may not impose a non-quantitative treatment limit (NQTL), including a prior authorization requirement, only to buprenorphine if the requirement is applied more stringently to buprenorphine than to other prescription drugs (FAQ 6).
- A plan may not require a patient to fail non-pharmacological treatment for opioid use disorder before authorizing coverage for buprenorphine if a similar fail-first requirement does not apply to comparable medical/surgical treatment (FAQ 7).
- A plan cannot require prior authorization for buprenorphine at every refill (every 30 days) unless it provides evidence to show a similar application of comparable processes, strategies, evidentiary standards and other factors to determine prior authorization requirements for prescription medications to treat medical/surgical conditions (FAQ 8).
- A plan cannot exclude court-ordered treatment for substance use disorders if it does not exclude court-ordered treatment for medical/surgical conditions (FAQ 9).
Joint Statement on Federal Mental Health and Substance Use Disorder Parity Task Force Report
ASAM joined its addiction and mental health advocacy allies in issuing a joint statement in response to the Task Force report. Read the statement here.