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Parity rules challenge stakeholders

November 16, 2015
by Julie Miller, Editor in Chief
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For those who wonder if parity will ever be a reality, know that work is being done to move closer to the implementation that was envisioned by lawmakers. According to experts presenting during a National Council for Behavioral Health webinar today, stakeholders are struggling to set the benchmarks for parity.

Bradley Lerner, associate general counsel and director of parity compliance for Beacon Health Options, says the hard part is finding the right parallel to use as a comparator for behavioral health to ensure compliance. For example, speech therapy or certain types of applied behavioral analysis might have caps on the number of visits or the age limit recommended for a child with autism, as set by state law.

“Nonquantitative treatment limits have some subjectivity, so you will see different approaches to methodology,” Lerner said.

While audits will drive the ultimate enforcement of the rules, the audit teams are not set up yet to measure and compare benefits to make the call on compliance, he said.

But the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is just one of the tools needed to ensure parity, said Marianne Burdison, senior director for strategic alliances at Cenpatico. Payer and provider partnerships to create new procedures that drive better comprehensive health are a big part of the equation, especially when stakeholders can demonstrate that access to behavioral health services makes financial sense.

For example, Cenpatico, which administers Medicaid programs, was able to show one state that requiring prior authorization for outpatient behavioral services was not cost effective, in part because of the administrative burden but also because the patient’s alternative was more costly inpatient services. It was a sound financial decision to remove the prior authorization requirement.

“Parity implementation is one part of the move toward healthcare reform in a system that ultimately will be about whole person care and recovery, and we only have some of the tools,” she said. “We are working as fast as we can.”

Burdison likens parity to HIPAA rules. It took years for the rules to be put into practice and there were new questions and iterations along the way. Final rules for Medicaid parity—commercial health plans generally had to be in compliance as of January 2015—are expected by next summer.

Also see Parity remains tough, even in pace car state

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