If an entity covers Mental health and Substance Use Disorder (MH/SUD) treatment, that coverage must be equivalent to medical and surgical coverage as part of the sweeping Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Violations can mean big financial penalties for insurance companies.
“If you don’t treat them equally, you’re going to get into trouble,” URAC President and CEO Dr. Shawn Griffin told attendees of “Compliance Matters: How Mental Health Parity Plays a Role in Your Organization,” a recent webinar hosted by URAC. Additionally, the pressures of the COVID-19 pandemic have further exacerbated mental health conditions for many people in our communities and placed a brighter spotlight on the importance of behavioral health care along with diagnosis and treatment of physical issues such as diabetes and high-blood pressure, Griffin noted.
Lawsuits are occurring in cases of health plans and other payers not providing parity in their behavioral health treatment and coverage, Griffin said. One of the many challenges when working to comply is the fact that the law is somewhat vague and doesn’t always clearly explain how payers must demonstrate they are complying, Griffin and other experts said. “Plus, treating behavioral health the same as medical care is the right thing to do” even without a law mandating it, Griffin stressed.
“We see our job as a third-party, protecting patients, making sure they get the care they need,” Griffin said. “Most payers need some sort of guide to be successful” in attaining MHPAEA compliance, Griffin said. Equally important, URAC accreditation helps ensure if an organization says they are high quality, that they have the credentials to back it up.”
URAC’s commitment to behavioral health has a long history, Griffin noted. URACs role in the mental and behavioral health space span from case management accreditation in 1999 to the nation’s first mental health parity accreditation program in 2019. URAC is the only accrediting organization to have a program in MH/SUD parity.
Pamela Greenberg, President and CEO of the Association for Behavioral Health and Wellness, a trade association that has represented behavioral health providers and payers since 1994, told attendees her association’s members have been loud and clear about two of their biggest compliance challenges: documenting compliance and getting the information needed from medical and surgical providers in order to do a parity analysis.
“Unfortunately, many states have different requirements than the federal regulators,” Greenberg said. “There is no uniformity today, and that lack of uniformity means higher compliance costs and a huge administrative burden for health plans,” she added. They “have to submit a myriad of documents in order to demonstrate they’ve properly implemented parity.”
Kevin Malone, national parity expert and Senior Counsel with Epstein Becker Green, shared examples of how ParityManager™, URAC’s enterprise parity software solution, can help organizations become compliant. The tool was designed to help streamline data collection and maintenance both at single points in time, and on an ongoing basis to allow the flexibility to update as needed, Malone said.
“ParityManager is designed to marry the different data collection activities that state and federal agencies require with a nod to the reality that health plan operations are an organic entity, and must be able to make updates over time and if compliance needs change,” Malone said
He said other data collection tools fall short when it comes to parity compliance because “most of the data collection tools assume a static point-in-time analysis” and lack the flexibility required to get a handle on compliance. “ParityManager allows plans to produce a report at click of a button, and on an ongoing basis across the entire enterprise.” The result? “It’s much easier to maintain compliance, and plans can reduce their compliance workload and get everyone back to the main focus, which is providing care, not doing paperwork.”
Learn More about URAC's MH/SUD Parity Program and ParityManager™