Key U.S. senators put forward a tentative plan aimed at bolstering behavioral health parity in Medicare and Medicaid.
On Thursday, the Senate Finance Committee released a discussion draft bill on behavioral health parity in Medicare and Medicaid, a fifth in a series of similar proposed reforms.
Leading into 2022, the finance committee formed five bipartisan working groups to study aspects of behavioral health reform with a Democratic and Republican senator leading each. Sens. Michael Bennet (D-Colo.) and Richard Burr (R-N.C.) led the parity task force.
Among its provisions, the draft plan:
— Mandates that Medicare and Medicaid plan providers swiftly update provider networks; Medicaid Advantage plans would need to make updates within two days
— Funds new studies by the Government Accountability Office (GAO) to examine cost sharing and utilization of behavioral health services through Medicare Advantage
— Funds new GAO studies examining Medicaid reimbursement rates for behavioral health compared to medical or surgical services
— Includes new guidance from Medicare for enrollees’ use of partial hospitalization program (PHP)
“Mental health services are a critical health care need as our nation recovers from the pandemic,” Burr said in a news release. “This discussion draft lays a foundation for advancing sensible policies that bring to the forefront the importance of ensuring patients have the information necessary to make the best health care decisions for themselves and their families.”
In November, the Senate Finance Committee released a discussion draft bill on behavioral health integration within Medicare and Medicaid.
Behavioral health parity is a hot topic in the behavioral health segment — both for providers and for payers.
Payers have been frustrated by the lack of clarity around the compliance reporting process for parity. Health plans have been waiting for more than two years for guidance on the matter from federal agencies.
Providers have long claimed that they have gotten short-shrift from payers and regulators alike on receiving comparable treatment to physical health care providers. The House of Representatives on Sept. 29 passed the Mental Health Matters Act which, among several things, gives parity enforcement more teeth.
Looking ahead, behavioral health parity faces uncertainty and some hope.
Axios reported Friday that Rep. Paul Tonko (D-N.Y.) said he’s confident that a package of behavioral health bills, dubbed the Restoring Hope for Mental Health and Well-Being Act (H.R. 7666), will be passed via the omnibus government funding bill. Tonko is a sponsor of some of the bills melded into H.R. 7666. The House of Representatives passed the bill in June on a 402-20 vote.
Earlier in the year, an appeals court reversed a lower court decision that eliminated health plans’ ability to make medical determinations based on anything but medical necessity. The plaintiffs in the case are seeking a rehearing.
Companies featured in this article:
