Path Forward’s Post

Mid week read: Here is a compliance read from AssuredPartners blog. 5 main points if you don't have time to read through it: Release of MHPAEA Guidance: On July 25, 2023, the U.S. Departments of Labor, Treasury, and Health and Human Services issued guidance to clarify and enhance compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA). Equitable Access to MH/SUD Benefits: The primary goal of this guidance is to ensure that individuals can access mental health and substance use disorder (MH/SUD) benefits as easily as they can access medical or surgical (M/S) benefits, without more restrictive limitations. Enhanced Comparative Analysis: The guidance emphasizes the need for an in-depth comparative analysis of non-quantitative limitations (NQTLs) on MH/SUD benefits compared to M/S benefits, with new requirements such as certification by plan fiduciaries. "Meaningful Benefits" Obligation: Plans are now obligated to provide a range of services and treatments for MH/SUD benefits if comparable M/S benefits in the same category offer such coverage. Compliance and Enforcement: Plan sponsors should already be working to ensure MHPAEA compliance. The proposed rules introduce auditing and corrective actions in case of non-compliance, making it crucial for plan sponsors to stay informed and seek assistance as needed. https://lnkd.in/eTtWjt5R

🤔 problem: heightened demand for treatment. too many patients, not enough therapists. step 1: ban treatment gaps and waitlists for all emotional and behavioral health step 2: ????? step 3: magical increase in providers? “The COVID-19 pandemic has produced a huge increase in the demand for the treatment of mental health and substance use disorders. A new law – SB 221 – coming into effect July 1, 2022 aims to strengthen access to mental health services. Your clients may be interested in knowing the details. Under existing law, California health plans must ensure their network of providers, including doctors, can provide enrollees with an appointment within a specific number of days or hours. Under the new law effective July 1, 2022, this requirement now extends to treatment for mental health and substance use disorders. You can find more background to the new law in a recent CaliforniaHealthline article. The California Department of Managed Health Care (DMHC) has also produced a Timely Access to Care fact sheet.” #nonsolution #lawsarefunny #thanksimcured #accesstocare #mentalhealth #behavioralhealth #soundedgoodonpaper

Ghost networks are a persistent problem in mental health care. Headway exists to fix this systemwide challenge at its core. We believe that making it easy for providers to actively practice in-network is critically important. By enabling providers to make this choice, health plans can have active networks and gather data that helps members get care. Thanks to Morgan Gonzales at Behavioral Health Business for talking with us about our solution to root out these deep challenges and build a new mental health care system everyone can access. Read more here: https://lnkd.in/gjUuzj5A

Recently proposed legislative updates may improve the enforceability of behavioral health parity rules, according to ECGMC’s Katy Shropshire and Kate Middleton. These updates could have significant implications for payers, providers, and patients alike. As we recognize May as Mental Health Awareness Month, it's important to continue the conversation around mental health parity and behavioral health parity. Stay tuned for more updates on this important issue. #mentalhealthparity #behavioralhealthparity #MentalHealthAwarenessMonth

The proposed updates to the Mental Health Parity and Addiction Equity Act could be a major step in ensuring that behavioral health coverage is treated like medical and surgical coverage. The key focus on outcome data as a tool to assess compliance will hopefully lead to improved outcomes for those with mental health and addiction challenges. #MentalHealthParity #BehavioralHealthCoverage #OutcomeData #EquityInHealthcare Let’s discuss how employers, insurers, and other stakeholders can fully implement these proposed updates to ensure parity between physical and mental health coverage. Share your thoughts with me in the comments and let’s work together to promote equity in healthcare! #EqualityInHealthcare #UnlockMentalHealth https://ow.ly/EL7S50PT6So

As mental health parity rules are proposed to be updated, it signals an important shift towards using outcome data to ensure compliance. This could lead to improved access to mental health services by making sure that policies and plans reflect the needs of consumers. #MentalHealthParity #WellnessMatters #OutcomesData #AccessToCare #HealthcareEquity What do you think about the proposed updates to the mental health parity regulations? Share your thoughts on the new focus on outcome data as a tool to assess compliance! https://ow.ly/LVqH50PT6OA

What is mental health parity? The 2008 Mental Health Parity and Addiction Equity Act requires insurance plans to provide mental health and substance abuse disorder (SUD) benefits on par with medical/surgical benefits. Your insurance plan cannot impose stricter quantitative or non-quantitative treatment limitations to your mental health benefits than it does to medical/surgical benefits. If you’ve had mental health or SUD treatment claims denied, don’t be afraid to challenge or ask questions about coverage and benefits. Advocate for yourself and your loved ones. Here’s AARP’s comment supporting efforts to better enforce mental health and SUD parity laws, drafted by yours truly. https://lnkd.in/gJKayTXg

"Fortunately, the following guide on understanding mental or behavioral health benefits will help you learn more about this topic and equip you with the information you need to make smart decisions about your care." https://lnkd.in/gCEwPHsj

Being a doctor is harder now than it has ever been. Apart from reading and studying constantly to keep up with changes and offer the best care possible to patients, doctors have to learn to get past the risk of being sued even if they do everything right. The stress of having to pay $1500 a month in loans after 12+ years of school can be overwhelming. The healthcare payment system is causing moral injury to physicians. Documentation rules require more time than being with the patient. Insurance prior authorizations tell doctors that they won't pay for their treatment plan because of bureaucracy. They have to change a patient's insulin because of formulary restrictions, which can result in the patient being admitted to the ER with high blood sugar, leading to the practice being penalized financially. Doctors may have to process 30 drug changes between January 1st and January 15th due to formulary changes, which is unpaid time that puts our patientsat risk for negative event. Doctors are being second-guessed constantly and forced to recommend suboptimal care like write for less expensive chemotherapy even though there is a better product for their patient, but they can't afford to pay it outside of insurance. These are just some examples of how the healthcare payment system is causing moral injury to physicians, leading to the deep black pit of burnout that many of them find themselves in. There are no yoga classes or wellness programs that will fix this problem, until we have revolutionary change in the heath insurance or payment systems. In the short term, talking about it, letting doctor's know they are not alone, employers allowing real treatment without penalty are some things that can help prevent physician suicide. For the long term, major change is necessary.

Check out SAMHSA’s “Coordinated Specialty Care for First Episode Psychosis: Costs and Financing Strategies” report and webinar discussing how Coordinated Specialty Care (CSC) can improve the quality of life and social and clinical outcomes for individuals experiencing a first episode of psychosis (FEP). This report and webinar from the Center for Financing Reform and Innovation discuss the positive outcomes of providing CSC services as well as costs, and approaches being taken to improve funding for this effective mental illness treatment service. https://lnkd.in/eSJmSjt9