Joint Committee on Financial Services
The Massachusetts Health & Hospital Association (MHA), on behalf of its member hospitals, health systems, physician organizations and allied healthcare providers, appreciates this opportunity to offer comment in strong support of HB910/SB588, An Act relative to mental health parity implementation.
MHA commends the legislature for the many efforts it has undertaken in recent years to strengthen mental health parity protections and enhance access to services. These important steps have resulted in meaningful benefits for patients. Yet despite these advances, true parity in accessing mental health services remains elusive. This disparity is highlighted by the numerous administrative barriers to timely and appropriate services that still exist. These barriers contribute to the daily boarding of patients in hospital emergency departments as they await needed inpatient-level services and care, and hamper the ability of inpatient units to expeditiously admit patients and adequately fund care.
HB910/SB588 has two critical prongs to improve mental health parity. First, this legislation would require payers to report how they apply medical necessity criteria and non-quantitative treatment limits (NQTLs) to both their behavioral health benefits and their medical and surgical benefits. As behavioral health providers frequently report difficult administrative processes, including those for concurrent and retrospective review that see authorizations for treatment reversed or reduced while a patient is receiving treatment, this provision will provide needed transparency as to how behavioral health benefits are administered compared to medical and surgical benefits.
Since by definition NQTLs are non-quantitative, it is difficult to ascertain the effect that administrative processes like concurrent and retrospective review have on parity. HB910/SB588 will provide necessary information on the status of parity in Massachusetts. While data is limited, a recent report issued by Milliman – Addiction and mental health vs. physical health: Analyzing disparities in network use and provider reimbursement rates – sought to determine the effect of NQTLs on parity. The report, which undertook a state-by-state review of network utilization for both medical/surgical care and behavioral healthcare, found that in 2015 Massachusetts Preferred Provider Organizations (PPO) plans saw out-of-network inpatient facility utilization at a rate of 2.9% for medical/surgical care and 16.8% for behavioral healthcare, indicating network adequacy issues with behavioral health networks.
The inclusion of provider reimbursement rates in HB910/SB588’s definition of NQTLs is a particularly important aspect of determining parity. Behavioral health rates have historically been low. In fact, the Attorney General’s 2015 Examination of Health Care Cost Trends and Cost Drivers report found that “consistently negative margins for behavioral health services across all types of general acute hospitals are indicative of historically low behavioral health reimbursement rates.” The report goes on to say, “Among 18 general acute care hospitals that reported inpatient behavioral health margins for commercial and government business from 2010 to 2013 – including academic medical centers, teaching hospitals, community hospitals, and disproportionate share hospitals across all geographies – the cumulative margin for all of these hospitals over those four years was negative 39%.” These low rates ultimately limit patient access to behavioral health services, in addition to limiting those that enter and stay in the behavioral health workforce.
HB910/SB588’s second prong requires the Division of Insurance to ensure compliance with parity and evaluate consumer and provider complaints of parity violations. This increased oversight will help identify which payers are compliant with parity. HB910/SB588’s provision creating a mechanism for providers to report parity violations is critical, as providers may be in a better position than consumers to identify parity violations, especially those related to administrative processes.
The provisions of HB910/SB588 would provide necessary information regarding payer compliance with mental health parity and establish compliance mechanisms in order to ensure that patients have access to mental health services.
Thank you for the opportunity to offer comments on this important matter. If you have any questions or require further information, please contact Michael Sroczynski, MHA's Senior Vice President of Government Advocacy at (781) 262-6055 or msroczynski@mhalink.org