Cigna Corp. and the Blue Cross and Blue Shield Association say the federal government should put new behavioral health parity compliance rules through a formal review period, not package them as an informal batch of advice.

The Employee Benefits Security Administration, the Internal Revenue Service and the U.S. Department of Health and Human Services have tried to put new parity compliance guidelines in a set of answers to frequently asked questions about implementation of the Affordable Care Act.

Technically, the answer is just an informal batch of advice, not a regulation. The Obama administration "tri agencies" said in their answer, in October, that they want health insurers and health plans to explain their reasoning when they refuse to cover mental health or addiction treatment services.

The Mental Health Parity and Addiction Equity Act of 2008 and federal regulations based on the Affordable Care Act require plans to cover physical health and behavioral health services using the same "quantitative limits," such as deductibles and office visit frequency limits.

Plans are also supposed to offer parity when it comes to "nonquantitative treatment limits," or matters such as prescription drug formulary design and standards for letting providers participate in a plan's network.

Officials also have said that plans should disclose all formulas, standards for evidence, and other instruments used to make behavioral health coverage decisions. They suggested they could develop one, or several, model notices to help plans share information about behavioral health benefits decision processes with the patients.

Officials did ask for comments on their advice.

But David Schwartz, an executive at Cigna's federal affairs unit, and Slackman, a regulatory policy specialist in the Washington office of the Blue Cross and Blue Shield Association, write in their comment letters that the tri agencies should handle the matter through the formal rulemaking and paperwork creation processes, not rush any new form or forms out in informal guidance.

Confusion warning

Slackman warns against the government creating forms that give a few examples of bad coverage decisions, rather than a complete list.

If the government creates an incomplete form, that could drive up costs by creating "a proliferation of additional disclosures, which in turn would lead to confusion (and higher administrative costs) as to what disclosure is being requested and what must be supplied in response," he says.

Schwartz says Cigna likes the idea of creating a simple, consumer-friendly disclosure form, but giving plans a choice of whether to use the form or not.

"We strongly recommend that the content of the form go through the regulatory notice and comment period process to allow for sufficient public input and to ensure that the model form does not create any new disclosure requirements or conflict with or confuse existing disclosure requirements," Schwartz writes.

Cigna is based in Bloomfield, Connecticut.

Carmella Bocchino of Washington-based America's Health Insurance Plans suggested that regulators should develop any model disclosure forms at the same time they implement the mental health provisions in the new 21st Century Cures Act.

Brian Marcotte, president of the Washington-based National Business Group on Health writes in his comment that complying with the parity rules is difficult, and that the evidence for some mental health and addiction treatment benefits is weaker than the evidence for many medical benefits.

"For example," Marcotte writes, "it is difficult to obtain data from many substance use disorder treatment programs regarding short or long-term outcomes for pateints, which evaluation of the programs' effectiveness difficult."

Instant Insights /

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