Credit: Roman Samborskyi/Shutterstock
State insurance regulators and health insurers may need a counselor to help them work through their conflicts over new mental health parity compliance efforts.
The dispute involves "parity," or state and federal rules that require any mental health or addiction treatment benefits that a plan offers to be similar to the plan's medical benefits.
Plans have gotten used to providing parity for copayments and deductibles, but now they're having to provide parity for "nonquantitative treatment limits," such as how easily plan enrollees can see the providers and how easily patients can get inpatient care.
Regulators and insurer frustration with the NQTL reporting process bubbled up Wednesday in Hollywood, Florida, at a meeting of the National Association of Insurance Commissioners' Mental Health Parity and Addiction Equity Act Working Group.
The states' perspective: Dr. Leanette Henagan, a regulator from Arizona, said the Arizona Division of Insurance tried to work closely with insurers and plan administrators to develop a workable reporting process, but that the NQTL reports the division is getting are not very good.
One problem is that insurers lump many different types of NQTL provisions together in one analysis, instead providing the data and analysis regulators need to tell whether the NQTLs for medical and behavioral benefits are really comparable, Henagan said, according to a copy of her slidedeck posted by the working group.
Another problems is that some insurers fail to show their analytical work, Henagan said.
Viara Ianakieva and Jessica Sanchez, two regulators from New Mexico, said the New Mexico Office of Superintendent of Insurance now ask for raw prior authorization and retrospective review data because the reports insurers filed failed to provide enough information for regulators to evaluate parity compliance.
"Often carriers interpreted the laws narrowly or differently from OSI, especially regarding NQTLs, provider reimbursements and network adequacy requirements," according to Ianakieva and Sanchez.
The plans' perspective: Lisa Campbell, a principal with Groom Law Group, told the parity working group that plans are having trouble with parity reporting because each state is developing a different reporting system.
In some cases, Campbell said, states are failing to give clear explanations of what they want or asking for data, such as information about coverage for individual services, that's hard to provide.
The U.S. Department of Labor has developed a "self-compliance tool," or list of standards and questions plans can use to decide if they have achieved NQTL parity, and state adoption of the Labor Department compliance tool would help insurers understand what states want, Campbell said.
© Arc, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.