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Questions about Essential Health Benefits, Medicaid Expansion, and Parity Enforcement?

May 22, 2013
by Dennis Grantham, Editor-in-Chief
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While attending the National Association of Addiction Treatment Providers’ (NAATP) convention this week, I learned that many providers are looking for state-specific updates regarding essential health benefits, state decisions about the Medicaid expansion, and local/national enforcement efforts surrounding parity in mental health and addiction treatment.   Here’s a quick collection of some resources that Behavioral Healthcare can offer, with links to other helpful sites:

1) Check:  What are your state’s essential health benefits? 

At one time, it was hoped that essential health benefits would be spelled out in the Affordable Care Act.  However, the group assigned to review EHBs, the Institute for Medicine (IOM), was persuaded that a single national standard would be too costly for small employers to afford.  Therefore, an alternate specification was drawn up, enabling states to select essential health benefits from any of four options, with the default being the largest small employer plan in the state.

For details about the essential health benefit plans in any state, go to:

http://www.cms.gov/cciio/resources/data-resources/ehb.html#review benchmarks

2) Check key updates on Medicaid expansion and Essential Health Benefits in Behavioral Healthcare:

What can still go wrong with health care reform

Leadership practices for behavioral healthcare

The hottest idea in healthcare:  Public money for private insurance?

Action regarding essential health benefits needed now  (Excellent summary of EHB options and concerns and how they developed.)

CMS won’t reward states that do partial Medicaid expansion

Rating the value of health insurance policies:  ‘Metal levels’

 

3) Check the status of state decisions on Medicaid coverage:  Here are two websites that specialize in tracking progress on the Medicaid expansion:  

http://www.statereforum.org/states/indicator/eligibility  — The State Reforum blog site offers an in-depth profile of the latest in each state, ranging from the governor’s position to the positions of key legislators.

http://www.advisory.com/Daily-Briefing/2012/11/09/MedicaidMap  — This group offers a simpler and more visual representation that lends more weight to the position of each state’s governor on the question of Medicaid Expansion. Not as detailed as the State Reforum site.

4) Check on parity enforcement:  Overall, the federal government has only weakly enforced parity, while the issuance of a parity final rule has been delayed for years.  Parity enforcement of parity’s interim final rule has defaulted, in the meantime, to state insurance boards.  I have heard it speculated, more than once, that weak enforcement of parity is a sop to health insurers whose support is needed by the Administration to execute on the insurance expansion some six months from now.

However, the Parity Implementation Coalition has been active in the parity fight and The American Psychiatric Association (APA) has been actively seeking out parity-related complaints as the basis for lawsuits and has been pursuing legal cases around the country. One recent case, in Connecticut, is the topic of recent coverage in Behavioral Healthcare.

To report a suspected parity violation, e-mail concerns to: CPTParityabuses@psych.org

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