Even in states with a successful track record in pursuing insurers for violations of the federal parity law, the monitoring of insurer behavior never ends, members of a panel on the current state of parity said May 16 at the National Association of Addiction Treatment Providers (NAATP) annual conference.
“You win, and then it's the next thing,” said Greg Heller, a Pennsylvania trial lawyer who has prevailed in cases against commercial insurers and federal Blue Cross plans and has worked on behalf of the Drug and Alcohol Service Providers Organization of Pennsylvania (DASPOP). He advised the audience at the panel session, “We can never give up defending residential [treatment].”
A recurring theme in the 90-minute session spoke to how little time many states are spending in fulfilling their role to enforce the federal parity law adopted eight years ago. Sherri Layton, outpatient services administrator at La Hacienda Treatment Center in Texas, said officials in her state have focused more on opposing the Affordable Care Act (ACA) than on monitoring parity implementation. “It's so difficult to file complaints with the state Department of Insurance,” Layton said.
A lack of oversight of parity caused the New York Attorney General's Office to step in and use scores of public complaints against insurers to build legal cases. The companies with which the state has achieved legal settlements were traditionally denying about half of claims for residential substance abuse treatment, a rate far in excess of denials in the med/surg arena, said Lisa Landau, chief of the Health Care Bureau in the AG's office.
In one of the state's first victories, Landau explained, it was able to stop Cigna's practice of not covering nutritional counseling for patients with eating disorders, even though it routinely covered the counseling for patients with illnesses such as diabetes.
Landau offered a mixed assessment of how the widely publicized settlements in New York have affected insurer behavior. “We've seen denial rates decrease in some instances,” she said. “Even in settlement, there still is work to be done.”
Heller pointed out examples of egregious abuses that led to successful prosecutions of cases against insurers—actions that generally have to be carried out one patient case at a time. Responding to audience questions, he said that class-action filings in this area can take years to unfold, and added that advocates in Pennsylvania have not been able to convince state prosecutors that some insurers' denials justify the filing of criminal charges.
While enforcement of parity mandates largely has fallen to the states, NAATP's public policy representative in Washington, D.C., mentioned several federal initiatives that indicate this will be a priority topic in the remaining months of the Obama administration.
The administration has embarked on a market conduct survey that is expected to lead to enforcement mechanisms, and also is developing long-awaited formal enforcement guidance for states, said Mark Dunn of Dunn and Associates.
He said NAATP also will be submitting comments to a new White House task force on parity, and he urged audience members to participate as well, saying that the volume of comments and data catches this administration's attention.