CEO Update 159

United Healthcare Sued by Labor Department

The US Department of Labor (DOL) has sued UnitedHealthcare and United Behavioral Health alleging the companies systematically limit coverage of mental healthcare more than medical and surgical care in violation of the Mental Health Parity and Addiction Equity Act and the Employee Retirement Income Security Act. The complaint filed by the DOL specifically points to discrepancies in reimbursement rates for out-of-network, non-physician mental health providers compared to rates for medical and surgical providers. In addition, the DOL complaint refers to a concurrent review program for outlier or unusual services that the companies apply broadly to all outpatient mental health benefits but only to a “very select set” of medical/surgical benefits. The complaint was filed as Walsh v. United Behavioral Health in the US District Court for the Eastern District of New York on Wednesday, Aug. 11, 2021.

The New York attorney general also sued UnitedHealth Group, United Behavioral Health, UnitedHealthcare and Oxford Health Plans, claiming the companies violated both federal and state mental health parity laws.

The companies will pay $2.5 million to resolve the Labor Department claims, $1.1 million to resolve the state’s claims, and $10 million to resolve private class action claims, according to two separate settlement agreements with the regulators and private parties.

 

Senate Finance Committee Launches Bipartisan Effort to Address Barriers to Mental Health Care

Senate Finance Committee Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) announced plans to develop bipartisan legislation addressing barriers to mental healthcare in a letter to Committee members issued Aug. 5, 2021. The letter requested proposals regarding the following issues in particular:

• Addressing the behavioral health workforce shortage,
• Supporting care integration, access, and coordination efforts,
• Improving oversight, data reporting, and enforcement of mental health parity laws, and
• Expanding access to telehealth services for behavioral health care.

The letter also cited Committee interest in enhancing mental health crisis care and addressing gaps in care for high need groups including individuals with serious mental illness, those experiencing homelessness, and individuals involved in the child welfare system. The letter also referred to the need to improve pediatric mental healthcare and strengthen prevention and treatment options for substance use disorders. Proposals from Committee members are due before Aug. 31, 2021. The letter also states the Committee will issue a separate request for input from public- and private-sector stakeholders. NABH is working on several fronts to ensure our legislative priorities are addressed as part of this initiative.  

California Mandates Covid-19 Vaccine for Healthcare Workers

The California Department of Public Health issued an order on Aug. 5, 2021 requiring workers in healthcare facilities to be vaccinated for Covid-19 by Sept. 30, 2021. The order explicitly applies to hospitals, acute psychiatric hospitals, chemical dependency recovery hospitals, clinics and doctor offices (including behavioral health), residential substance use treatment and mental health treatment facilities, as well as other healthcare facilities. Workers subject to this requirement include those that are paid and unpaid including nurses and nursing assistants, technicians, therapists, students and trainees, contract staff not employed by the facility, and persons not involved in patient care but who could be exposed to infectious agents including clerical, dietary, environmental services, laundry, security, engineering and facilities management, and volunteer personnel. Workers may seek an exemption based on religious beliefs or qualifying medical reasons corroborated in writing by a state licensed medical professional. Exempt workers must wear masks and be tested weekly. Healthcare facilities are required to maintain records of workers’ vaccination status and provide such records to local or state public health officials upon request.  

SAMHSA to Host Virtual Roundtable about Creating a Diverse Behavioral Health Workforce on Aug. 18

SAMHSA’s National Network to Eliminate Disparities in Behavioral Health will host a virtual roundtable later this month to discuss strategies that motivate racially and ethnically diverse individuals to consider behavioral healthcare as a career path. The event will address how community-based organizations are working to diversify the behavioral health workforce, such as recruiting and retaining a racially and ethnically diverse staff. SAMHSA will host the virtual roundtable on Wednesday, Aug. 18 at 1 p.m. ET. Click here to learn more and register.  

Joint Commission Behavioral Healthcare and Human Services Webinar Series

The Joint Commission will hold weekly webinars starting Aug. 24 for behavioral healthcare professionals responsible for meeting accreditation standards and survey compliance. These sessions will address the following topics:

• Information Management (IM), Record of Care, Treatment and Services (RC),
• Medication Management (MM),
• Environment of Care (EC), Life Safety (LS),
• Human Resources Management (HRM),
• Leadership (LD), Performance Improvement (PI),
• Infection Prevention and Control (IC),
• Care, Treatment, and Services (CTS),
• Emergency Management (EM),
• Safety Systems for Individuals Served (SSIS),
• Rights and Responsibilities (RI), Waived Testing (WT), and
• National Patient Safety Goals (NPSG).

Here’s a link to the registration page on the Joint Commission website.  

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is a new resource for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.  

Register Today for the NABH 2021 Annual Meeting!

Registration is open for the NABH 2021 Annual Meeting from Wednesday, Oct. 6 – Friday, Oct. 8, 2021 at the Mandarin Oriental Washington, DC. We hope you join us as we recognize our meeting theme, Expanding Access: Right Care. Right Setting. Right Time. Please visit our Annual Meeting webpage to register for the meeting and to reserve your hotel room. We look forward to seeing you in Washington!  

Fact of the Week

Mental illness and substance use disorders were among the top five reasons for inpatient treatment in community hospitals among individuals under 45 years old in 2018 according to a statistical brief issued by the Agency for Healthcare Research and Quality. For questions or comments about this CEO Update, please contact Kirsten Beronio.