HHS, Treasury, and Labor Departments Release Parity Report to Congress
The Departments of Labor (DOL), Health and Human Services (HHS), and Treasury issued a
report and fact
sheet on Tuesday, Jan. 25 documenting widespread lack of compliance with federal parity rules among commercial health plans. The report specifically highlights lack of compliance with a new requirement enacted in late December 2020 that plans must document how their non-quantitative treatment limitations (NQTLs) comply with the Mental Health Parity and Addiction Equity Act (MHPAEA).
During a webinar on Wednesday, Jan. 26, DOL representatives stressed that none of the responses to requests for documentation the agency sent to 156 plans and issuers were sufficient to demonstrate compliance with MHPAEA. Furthermore, despite insufficient documentation, DOL has already issued initial determination letters finding 48 NQTLs imposed on mental health or substance use disorder (MH/SUD) benefits violate parity. HHS reported that all the responses to requests for documentation of compliance with parity from issuers in states where the agency has direct enforcement authority and non-federal government plans similarly were insufficient. HHS has issued initial determination letters finding 16 NQTLs were out of compliance with parity. DOL officials also mentioned that the agencies plan to amend the federal regulations implementing MHPAEA.
The Departments included a set of legislative recommendations for Congress in the report including authorizing the Departments to impose civil monetary penalties for parity violations and directly pursue parity violations by entities that provide administrative services to group health plans. In addition, the report recommends that Congress consider ways to permanently expand access to telehealth. The report also recommends that Congress amend MHPAEA to ensure that MH/SUD benefits are “defined in an objective and uniform manner pursuant to external benchmarks that are based in nationally recognized standards”.
These developments regarding possible regulatory and legislative changes point to the importance of NABH member submissions to the denial-of-care portal. Please see additional information about the portal below.
CMS Issues Updated Guidance on Covid-19 Vaccination Requirements for Healthcare Workers
The Centers for Medicare and Medicaid Services (CMS) issued updated guidance and resources regarding Covid-19 vaccination requirements for personnel in Medicare-participating facilities including psychiatric hospitals and psychiatric residential treatment facilities. This updated information responds to the Supreme Court’s decision earlier this month to overturn the lower court decisions blocking implementation of CMS’ Covid-19 vaccination requirements in almost half of the states. These requirements now apply in all 50 states with various deadlines.
In the 25 states not affected by the litigation, CMS had previously clarified that healthcare facility personnel had to have at least one dose of a Covid-19 vaccine (or be exempt due to religious conviction or medical condition) by Jan. 27, 2022, and a second dose (of any two dose regimen) by Feb. 28, 2022.
New deadlines for healthcare facility personnel in states previously under a stay on enforcement are Feb. 14, 2022, for a first dose and March 15, 2022, for a second dose. Texas was affected by separate litigation and the new deadlines for Medicare-regulated healthcare facilities in that state are Feb. 22, 2022, for the first dose and March 21, 2022, for the second.
Below are links to updated CMS guidance on the Covid-19 vaccination requirements:
OSHA Withdraws Vaccine-or-Test Requirement
The U.S. Supreme Court, on Jan. 13, 2022, blocked implementation of the Occupational Safety and Health Administration’s (OSHA’s) vaccination and testing requirements for employers with 100 or more employees. Accordingly, the agency
withdrew its emergency temporary standard (ETS) on this topic. However, the agency clarified that “[a]though OSHA is withdrawing the ETS as an enforceable emergency temporary standard, the agency is not withdrawing the ETS to the extent that it serves as a proposed rule.” In a
statement on the withdrawal, the agency clarified it is “prioritizing its resources to focus on finalizing a permanent Covid-19 Healthcare Standard.”
HHS Distributes More Than $2 Billion in PRF Phase 4 Funding
HHS’ Health Resources and Services Administration (HRSA) this week is making more than $2 billion in Provider Relief Fund (PRF) Phase 4 general distribution payments to more than 7,600 healthcare providers nationwide.
These payments follow nearly $9 billion that HRSA released to providers last month. According to HRSA, a total of more than $11 billion in PRF Phase 4 payments have been distributed to more than 74,000 providers in all 50 states, Washington, D.C., and five territories.
HRSA
clarified that these payments reflect “full processing of approximately 82 percent of Phase 4 applications. The remaining applications require additional review as part of the risk mitigation and cost containment safeguards previously outlined in the
Phase 4 methodology”.
NABH and Other Behavioral Health Groups Send Letter to CMS about ‘No Surprises Act’ Rules
NABH and 10 other behavioral health organizations this week sent a
letter to the Centers for Medicare & Medicaid Services (CMS) expressing concern that the agency’s
No Surprises Act regulations will have a disproportionately negative effect on behavioral healthcare providers and add to their administrative burdens.
The
No Surprises Act’s, signed into law in late 2020
, requirements became effective this year. NABH and other groups have requested that CMS issue a stay on enforcement of the interim final rules (IFR) that affect routine mental and behavioral health services. If the agency insists on retaining the existing regulations, NABH and the other groups requested an exemption for behavioral healthcare providers.
“The duty to furnish a “Good Faith Estimate” (“GFE”) of costs outlined in Part 2 of the regulations imposes an undue administrative burden on our members,” the letter said. “Our providers have a long-standing practice of being transparent about fees with their patients because it is required by their professional ethics. Requiring clinicians to fill out the GFE form and update it every time there is a minor change in the treatment plan that may or may not have an impact on costs takes away from valuable treatment time – which is in extremely high demand as more and more people are struggling with the mental health impact of the COVID pandemic,” it continued. “Demand is already so high that many patients are finding it difficult to find a provider with enough availability to meet their needs.”
ONC Seeks Request for Information on EHR Standards for Prior Authorization and More
HHS’ Office of the National Coordinator (ONC) on Jan. 24, 2022, requested information about electronic health record standards for prior authorization, implementation specifications, and certification criteria for the ONC certification program to inform future rulemaking.
The request for information builds on a set of
recommendations made in November 2020 from the HHS Intersection of Clinical and Administrative Data Task Force (ICAD) of the Health Information Technology Advisory Committee (HITAC). The task force is addressing methods for improving data interoperability across the health ecosystem.
“We support efforts that can serve to advance electronic prior authorization for patients, providers, and payers,” Mary Greene, M.D., director of CMS’ Office of Burden Reduction and Health Informatics, said in an announcement. “We look forward to reviewing the input received on this RFI and to exploring opportunities for alignment between future ONC policymaking and ongoing CMS initiatives on this critical topic.”
Click
here to learn more about how to submit comments, which must be submitted by March 25.
CMS Releases Third Publication of T-MSIS-based Medicaid SUD Data Book
The percentage of Medicaid beneficiaries treated for a substance use disorder (SUD) who received any medication-assisted treatment increased by 7.8 percentage points to 31.6% in 2019 from 23.8% in 2018, according to CMS’ third publication of the
Transformed Medicaid Statistical Information System (T-MSIS)-based Medicaid Substance Use Disorder (SUD) Data Book.
Required by the
Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT) that Congress passed in 2018, the resource is meant to help policymakers, researchers, and others better understand where to focus drug-prevention and treatment efforts.
The data book contains 2019 data on Medicaid beneficiaries treated for SUD, the services they received by both type and setting, delivery system, and progression of care.
Register Today for National Drug and Alcohol Facts Week: March 21-27, 2022
The National Institute on Drug Abuse (NIDA) invites organizations to participate in National Drug and Alcohol Facts Week (NDAFW), a national health observance meant to empower teens and young adults about making informed decisions about drugs, alcohol, and addiction.
NIDA has developed five
steps to hosting a NDAFW event and created lessons
plans and other materials for educators, counselors, and prevention specialists. Click
here to learn how to register your organization’s event online
Reminder: NABH Denial-of-Care Portal is Open to Members
NABH’s Denial-of-Care Portal is available 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.
Fact of the Week
A new
study found that 62% of Americans surveyed prefer in-person mental health services.
For questions or comments about this CEO Update, please contact Jessica Zigmond.