[NYAPRS Enews] MHW: Essential Health Benefit Lacks MH Services Access Protections

[Harvey Rosenthal]

Field: EHB Does Not Ensure Protections For Mental Health Service Access

Mental Health Weekly  February 13, 2012

 

The mental health community while concerned that the U.S. Department of
Health and Human Services (HHS) is giving states too much latitude

in defining the Essential Health Benefit (EHB), also take issue with the
proposed benchmark plan approach that they say could result in leaner
coverage for mental health and substance use disorders.

 

The mental health community has expressed concerns that federal
leadership and even stronger oversight for parity implementation is
needed. The Mental Health Liaison Group and others in the field
submitted comments to HHS by the January 31 deadline. HHS officials plan
to release additional guidance although no timetable has been set.

 

Many of the comment letters expressed concerns for stronger oversight
for parity implementation and the need for more transparency in the
process for determining the benchmark plan along with the need to
maintain the ability to manage benefits regardless of the benchmark plan
that is chosen.

 

The Coalition for Whole Health in its comment letter raised concerns
about the proposal to use a small employer plan as the default benchmark

plan for states that do not exercise the option to select a benchmark
health plan. Small group plans are "the weakest and most variable
option," they wrote. Small employers have been exempt from complying
with the federal parity law and small group coverage is generally more
limited than what is offered by large group plans, they wrote. The
coalition is urging HHS to identify a large market plan or an HHS
defined comprehensive essential health benefits package as the default
benchmark plan.

 

Democratic House lawmakers expressed similar concerns. "We worry that
some of the benchmark plans, including the default benchmark plan, the
'largest plan by enrollment in the largest product in the state's small
group market,' could be very lean or contain restrictive amount,
duration, and scope limitations," Reps. Henry Waxman (D-Calif.), George
Miller (D-Calif.), and Pete Stark (D-Calif.), and others wrote in a
February 6 letter to HHS Secretary Kathleen Sebelius. They added,
"Without very careful protections, we have serious concerns about
delegating the decision for the EHB to the states and providing even
further discretion to insurers."

 

The Association for Behavioral Health and Wellness (ABHW) in their
comment letter wrote, "Without knowing what mental health and substance
use disorder benefit look like in all of the possible benchmark plans in
each state it is somewhat difficult for ABHW to provide detailed
commentary on

HHS' proposed approach for determining the EHB." ABHW is urging HHS to
release any information it has on all possible benchmark plans in each
state.

 

Stronger federal role

The Mental Health Liaison Group (MHLG), national organizations
representing providers, advocates, professionals, consumers and family
members, in its January 31 comment letter highlighted a few key points:

* Maintain strong federal role: The MHLG supports a comprehensive
essential health benefit package that provides a clear federal minimum
standard

(or national floor) to ensure coverage that meets the health care needs
of diverse populations, including individuals with disabilities and
chronic conditions.

* Parity for mental health and substance use disorders: We ask for
further guidance on the application of parity within the proposed
benchmark plan approach - not withstanding our support for defining, at
a minimum, mental health and substance use disorder services.

* State mandates and benefit design flexibility: We urge HHS to develop
an approach that requires states to provide all state mental health,
substance use and behavioral health treatment mandated benefits and
parity laws in the EHB. HHS should reject the benefit design flexibility
as we strongly believe it would create problems of adverse selection and
confusing and deceptive marketing practices by insurance companies.

 

Mental health advocates were concerned by the minimal approach the
federal government had taken in providing states with more discretion in
designing the benefit, said Laurel Stine, director of federal relations
for the Bazelon Center, and a member of MHLG. "We were taken aback by
HHS' approach." Stine told MHW. "This is a big issue and there's a lot
at stake." 

 

Without additional guidance and more transparency, consumers have no way
of knowing how to compare plans, she said. The mental health community
is very pleased, she said, about the strong language regarding the
mental health parity and substance use disorder benefit in the EHB;
however, we still need enforcement and federal oversight," Stine said.

 

The goal of the ACA is to provide meaningful coverage and create
uniformity across health plans, she said. "The HHS has also been silent
on the issue of medical necessity, which could be the crux between
whether someone has restrictive benefits or not," said Stine. 

 

Meanwhile, house lawmakers encouraged HHS to make all plan data
collected in the development of this policy publicly available as soon
as possible so that potential benchmark plans can be identified,
reviewed, and commented upon.

 

Comprehensive treatment required

Debra Wentz, Ph.D., CEO of the New Jersey Association of Mental Health
and Addiction Agencies, Inc., (NJMHAA), said further clarification of
what each of the potential benchmark plans must cover for mental health
and substance use disorders is needed. "The flexibility left to the
states opens the door for a continuation of mental health and addiction
and all disorders not being treated as comprehensively as was the
congressional intent," Wentz told MHW.

 

Wentz noted that the New Jersey Assembly Health and Senior Services
Committee passed legislation on February 6 that would create a statewide

health insurance exchange. During a hearing on the health insurance
exchange, the business community testified against the expansion of the
benefit, she said. "They said it would be too costly and a burden to
companies," Wentz said. It is important that the government show more
leadership, she said.

 

The federal definition of the EHB package should ensure that mental
health and substance use disorders are comprehensive and provide for the
full continuum of medically necessary services and should include
habilitation and rehabilitation services that will help consumers remain
healthy and live

in the community, she said. Wentz added, "If we are not able to obtain
full comprehensive coverage now, the door might close on that
opportunity." 

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