Guest Post by The National Parity Implementation Coalition www.parityispersonal.org
Last night 250 people attended the Parity Forum in Friendship Heights Maryland. The forum was chaired by Rep. Chris Van Hollen (D-MD) and attended by former Reps. Patrick Kennedy and Jim Ramstad and current Members Moran (D-VA) and Tonko (D-NY).
Three panels of witnesses made a strong case for the need for full and robust implementation and enforcement of MHPAEA.
PANEL ONE
- Dr. Paul Berger
- Ann Price
- Adrian & Diana Veseth-Nelson
PANEL TWO
- Dr. Josh Sharfstein, Secretary of the Maryland Department of Health and Mental Hygiene
- John O’Brien, Director of Health Care and Insurance, Office of Personnel Management
- Brenda Wilson, Associate Commissioner, Life and Health Section, Maryland Insurance Administration
- Dr. Raymond Crowel, Chief of Behavioral Health and Crisis Services, Montgomery Country Department of Health and Human Services
PANEL THREE
- Dr. Steve Daviss, Chair of Psychiatry, Baltimore Washington Medical Center
- Ellen Weber, Professor of Law, University of Maryland Francis King Carey School of Law Drug Policy Clinic
First Panel
During the first panel, Dr. Berger, a dentist in recovery from addiction, and Ann Price, a career flight attendant with PTSD and in long-term recovery from addiction, talked about their struggles trying to get their insurers to pay for their treatment.
Adrian and Diana Veseth-Nelson represented the veteran and military family voice; Captain Veseth-Nelson was medically retired from the Army last year after being diagnosed with severe PTSD following his second tour in Iraq. He and his wife Diana talked about the stigma associated with mental illness and the need for robust treatment for both veterans and their family members.
Second Panel
The second panel included local, state and federal government witnesses. First, Dr. Sharfstein, Secretary of the Maryland Department of Health and Mental Hygiene, spoke about the importance of the Affordable Care Act and said Maryland is committed to its full implementation unless stopped by the Supreme Court or some other body.
Following Dr. Sharfstein, John O’Brien with the Office of Personnel Management talked about parity in the Federal Employee Benefits Program (FEHBP). As you all know, President Clinton signed an executive order requiring parity for FEHBP plans. While FEHBP does not have to comply with MHPAEA, following the law’s enactment, FEHBP required its carriers to comply with the stronger protections (such as out-of-work parity) in MHAPAEA than in the existing FEHBP parity requirements. During the question and answer period following the panel’s statements, Rep. Kennedy asked Mr. O’Brien about recourse FEHBP takes with plans who are denying large numbers of claims and he replied that during the contract renewal process, they had made it clear to certain plans they were unhappy.
Brenda Wilson with the Maryland Insurance Administration talked about Maryland’s history with parity and the state’s efforts to comply with MHPAEA. During the question and answer period, Rep. Kennedy asked her why there had only been 30 complaints filed with her office in 2011 related to mental health and addiction treatment. She replied that they do everything they can go get the word out that patients have a right to appeal, but she suspected the nature of the illnesses make it very difficult for patients and family members to go through the arduous appeals process.
Dr. Raymond Crowel with the Montgomery Country Department of Health and Human Services spoke about how non-quantitative treatment limits in Medicaid often limit access to care and he emphasized the need for requiring outcomes reporting to ensure patients are getting the care they need.
Third Panel
On the third panel, Dr. Daviss with Baltimore Washington Medical Center echoed Dr. Crowel’s comments that non-quantitative treatment limits (NQTLs) often limit access to care. He talked about how obtaining pre-authorization for patients he sees in the emergency department who need to be admitted for psychiatric treatment is significantly more difficult than for patients his colleagues admit for medical/surgical treatment. He also spoke about lack of providers in networks, a phenomenon called “phantom networks” where plans lists providers in their networks who are not really available to treat patients.
Ellen Weber with the University of Maryland spoke about the need for a final rule that addresses the important outstanding issues of scope of service, NQTLs and application of MHPAEA to Medicaid managed care plans. Professor Weber talked about how it is difficult for patients to appeal because MHPAEA’s rules are complex, the plans control the information and patients and providers have limited capacity to spend the significant time required to file an appeal.
The next parity field hearing is in Minnesota on July 16. We hope you will encourage your Minnesota networks and affiliates to participate and attend. Details and updates about all of the upcoming field hearings can be found on the Parity Implementation Coalition’s website: www.parityispersonal.org