NABH Applauds Landmark Behavioral Healthcare Coverage Ruling in California
NABH applauded the decision filed in California’s Northern District earlier this week that will open access to behavioral healthcare services for those who need it.
“It has been 10 years since President George W. Bush signed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, and we have yet to achieve full parity,” NABH President and CEO Mark Covall said in a statement on March 5. “Today’s decision in California’s Northern District is a turning point. The federal court’s ruling made it clear that insurance companies must use generally accepted standards in the full behavioral healthcare continuum to help patients gain access to the care they need for recovery.”
In a nationwide class action lawsuit, the U.S. District Court for the Northern District of California on Tuesday held that United Behavioral Health (UBH) — the country’s largest managed behavioral healthcare organization — developed restrictive medical-necessity criteria that it used to deny coverage for outpatient, intensive outpatient, and residential treatment services.
According to the decision, the Court found that UBH’s internal guidelines limited coverage to acute care services, disregarding highly prevalent, chronic, and co-occurring disorders that required greater intensity and/or duration.
The Court also found that UBH failed to meet a requirement related to children and adolescents, asserting that although generally accepted standards of care do not require UBH to “create an entirely separate set of guidelines to address the needs of children and adolescents… they do, however, require that UBH’s guidelines instruct decision-makers to apply different standards when making coverage decisions involving children and adolescents, where applicable, including relaxing the criteria for admission and continued stay to take into account their stage of development and the slower pace at which children and adolescents generally respond to treatment.”
NABH is especially pleased to see the Court acknowledge that mental health and substance use disorders are chronic illnesses, and that managed care organizations must cover care that not only stabilizes the acute aspects of a patient’s illness, but also addresses a patient’s underlying condition.
President Trump Creates Task Force to Develop Blueprint for Suicide Prevention Among Veterans
President Trump this week signed an executive order creating a Cabinet-level task force to draft a blueprint for suicide prevention among veterans within one year.
The new President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide (PRESENTS) initiative will work to develop a grant system that extends funding to state and local programs and coordinate suicide-prevention research across agencies in the Veterans Affairs, Defense, and Homeland Security departments.
Bipartisan Group of Senators Ask HHS to Update Part 2
Thirteen U.S. senators this week sent a letter to HHS Secretary Alex Azar asking his department to initiate a rulemaking process to update the Confidentiality of Alcohol and Drug Abuse Patient Records 42 Code of Regulations 2, known as Part 2.
“Part 2 provisions are not compatible with the way health care is delivered currently,” said the letter from 7 Republicans and 6 Democrats. “In order to bring them in line with 21st Century medicine, it is imperative to modernize the regulations,” the letter continued. “Initiating a rulemaking process will open the door for necessary reforms, allowing for better coordination, safer and more effective treatment for patients, and stronger patient protections.”
Mental Health Liaison Group Sends Senate HELP Committee Behavioral Healthcare Priorities
Strengthening parity enforcement and compliance, stabilizing the health insurance marketplace, and integrating behavioral healthcare are the top three steps the federal government and the states could take to lower U.S. healthcare costs, the Mental Health Liaison Group said in a letter to the Senate Committee on Health, Education, Labor and Pensions (HELP) this week.
“In order to make meaningful, effective and long-lasting change within the U.S. healthcare system, we need to make long-term investments,” the letter said. “If we continue to look for cost-saving measures in the short-term, we will continue to fall short for American families, providers, and employers.”
NABH has been a longtime member of the Mental Health Liaison Group.
Missouri Hospital Association Examines Suicidality Rates After Psychiatric Hospitalizations Among Children
The 60-day suicidality rate following a psychiatric hospitalization nearly doubled for children and adolescents with insurance coverage that shifted from Medicaid fee for service to Medicaid managed care organizations in Missouri following statewide expansion of managed care in May 2017, according to a new report from the Missouri Hospital Association.
The report said the average length of stay at psychiatric hospitals for children and adolescents with Medicaid managed care coverage is 7.3 days, while the average duration is 12.5 for Medicaid fee-for-service patients “— a difference of 5.2 days, or 71 percent — which can be critical time needed to stabilize the child or adolescent before discharge back into the community.”
Child and adolescent suicide is a pervasive problem in Missouri, where it is the second-leading cause of death among children ages 5 to 19. Missouri had the 11th-highest rate of child and adolescent suicide in the country during 2017 with 6.4 suicide deaths per 100,000 children in this age group.
The Joint Commission Issues Ligature Risk and Suicide Risk Reduction Alerts
The Joint Commission this week sent two alerts regarding ligature risk and suicide risk reduction.
Thank you to Our 2019 NABH Annual Meeting Exhibitors and Sponsors!
The 2019 NABH Annual Meeting—Behavioral Healthcare: Improving Coordination, Collaboration, Integration— is a little more than one week away!
NABH thanks all of the companies that will serve as exhibitors or sponsors at the 2019 NABH Annual Meeting in March.
Please take a moment to view our exhibitors and sponsors on our Annual Meeting homepage, where you can click on each organization to learn more. Also, please remember to visit with our exhibitors and sponsors during the Annual Meeting from March 18-20 at the Mandarin Oriental Washington, DC.
We look forward to seeing you in Washington!
For questions or comments about CEO Update, please contact Jessica Zigmond.