In March, the president created a task force to examine parity in practice and arrive at recommendations and guidance for stakeholders to improve implementation. Its rather dense 34-page report arrived this week—there’s a lot to take in—but here are a few things that jumped out at me.
As you know, the ongoing challenge with parity is that the laws are difficult to enforce, partly because there is no true penalty for insurers that fail to follow them. Without an incentive for compliance, insurers might be tempted to drag their feet. Unfortunately, it’s typically discrete legal actions that drive plans’ policy changes—not a terrific option.
But among the nine enforcement recommendations in the report is one requesting that the Department of Labor be granted the authority to assess civil monetary penalties for parity violations in large employer health plans. Imagine that: fees for categorically denying coverage for treatment. This is one to watch.
Also, knowing that states are supposed to be responsible for enforcement, but they generally lack resources to do so, the Centers for Medicare and Medicaid Services has also earmarked $9.3 million in new grants to help state insurance regulators on the enforcement side. Some states, like New York for example, are cracking down on parity, so hopefully the grants will help other states get tough, too.
Observers tell me that enforcement tends to be after the fact. Insurers are examined only after consumers have complained about denials and burdens in obtaining coverage. The hope is that the intent of the parity laws will drive insurer behavior.
The most slippery violations to grab ahold of are what is known as non-quantitative treatment limitations (NQTLs). For example, requiring concurrent review before the plan will cover and extended episode of residential treatment is a NQTL. The reason why NQTLs are tricky obviously is because plans use similar limits on medical/surgical coverage already, so the question becomes how to establish what is “on par.”
It seems as if separate materials with examples and “warning signs” are going to serve as the guiding documents. The trouble is, someone in authority at the health plan will need to locate, digest and translate the material into action. Seems like a full time job to me. In fact, the National Council for Behavioral Health said in a statement that the group wants to see more guidance here.
Medication assisted treatment
Health plans are not applying consistent policies to medication assisted treatment. The task force wants new guidance prepared based on the content of consumer complaints. In that regard, National Council is also asking the administration to update its new FAQ posting, to reflect the fact that parity would apply to all the SUD medications. The current posting uses only examples of buprenorphine prescriptions.