Friday, June 12, 2015

APA Seeks Transparency Regarding Compliance with Mental Health Parity in New Regulations

APA wants Medicaid managed care plans and so-called Alternative Benefit Plans to be held accountable, through transparent disclosure of medical necessity criteria, for adherence to federal parity rules requiring comparable coverage of mental health and substance abuse treatment.

In a June 9, 2015 letter to the Centers for Medicare and Medicaid Services (CMS), APA CEO and Medical Director Saul Levin, M.D., M.P.A., applauded recently proposed regulations that extend mental health parity requirements to Medicaid managed care organizations (MCOs), the Children’s Health Insurance Program (CHIP), and Alternative Benefit Plans. "The application of the proposed regulations holds great promise for increasing access to medically necessary health care and for creating cost efficiencies that would otherwise be unachievable," Levin said.

But Levin also urged the agency to clarify regulations pertaining to documentation and disclosure of compliance with parity requirements. “…[T]he Proposed Regulations must strive for compliance with and accountability to the Mental Health Parity and Addiction Equity Act (MHPAEA) and its Final Rules,” Levin wrote. “Accountability can only be achieved through transparency, since this is the only basis for verifying true compliance. Full and public disclosure of all pertinent plan information that documents compliance with MHPAEA and the Final Rules is essential. This is a concern for all patients, but especially for Medicaid enrollees, whose ability to understand their benefits may be compromised.”

The 26-page letter is an extraordinarily detailed analysis of the federal proposed regulations that urges the agency to clarify a number of issues around transparency regarding compliance with parity. Among the recommendations in Levin’s letter is one that CMS stipulate “at a minimum” that documentation of compliance include a description of the methodology used by a state to perform the required regulatory tests for each applicable financial requirement, quantitative and nonquantitative treatment limitation, and all other parity requirements; the methodology used by the state to assure that there are no separate treatment limitations that apply only to mental health and substance use disorder benefits; and clear statements of the conclusions reached respecting each of these.

More information on mental health parity, including a two-page summary of APA's response to the proposed rule, can be found here.

(Image: Marco Rubino/


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