National Council for Mental Wellbeing

QUOTABLE “COVID-19 has accelerated and expanded our country’s mental health and substance use disorder crisis. Access to treatment – when and where people need it – remains the biggest challenge we face. Unfortunately, insurers have consistently fought to illegally deny equitable coverage and states have lacked the tools to hold them accountable. No longer.” – […]

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The Kennedy Forum hosted “Agenda for Change: Unite. Connect. Act.” last week, an event on Capitol Hill featuring members of congress, advocates, consumers, and philanthropists who discussed the current mental health crisis and steps for action.

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From funding for Certified Community Behavioral Health Clinics to state Medicaid waivers, 2020 is sure to be a whirlwind for behavioral health and for the health care system at large. While Congress remains split down party lines with Democratic control of the House and Republican control of the Senate, time will tell if any large changes will happen during this election year. Here is a preview of what is likely ahead in health policy in the first year of the new decade.

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Earlier this week, Senator Elizabeth Warren (D-MA) and Representative Joe Kennedy III (D-MA) reintroduced the Behavioral Health Coverage Transparency Act (H.R. 2874/S. 1576) with the aim of strengthening Americans’ access to mental health and substance use disorder (SUD) treatment. Specifically, the bill would increase oversight and enforcement of the federal parity law, which requires that insurance coverage of mental health and SUD services be equal to the coverage of medical and surgical health services. 

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In a landmark ruling, a federal court held Tuesday that health insurance giant United Behavioral Health (UBH), which serves over 60 million members and is owned by UnitedHealth Group, used flawed internal guidelines to unlawfully deny beneficiaries access to mental health and substance use treatment in an effort to cut costs. The ruling marks a validation for patients and providers who have long raised concerns that health plans were not fulfilling the requirements set forth in the Mental Health Parity and Addiction Equity Act of 2008, which established parity between the coverage of behavioral health and medical/surgical benefits.

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The Behavioral Health + Economics Network (BHECON), an initiative led by the National Council, is winding down on its second year of activities. BHECON partners with National Council state provider associations to transform the behavioral health delivery system by increasing their advocacy capacity and breaking down silos that create barriers to services for individuals with serious mental illness and co-occurring conditions. In its second year, BHECON translated the key state issues identified by stakeholders in year one, including mental health parity, workforce and increasing access to behavioral health services, into specific policy solutions in each of the nine states currently participating in the program.

Read More on BHECON’s 2018 Themes Show Key Issues Faced by State Behavioral Health Associations 

A newly released report evaluates the strength and quality of state laws created to ensure that health insurers treat illnesses of the brain, such as depression and substance use disorders, the same way they treat illnesses of the body, such as diabetes and cancer. The report assigns failing grades to 32 states, while the state of Illinois is identified as having a model state statute. The report offers recommendations for how states can improve their parity laws to ensure equal access to mental health and substance use disorder treatment.

Read More on 32 States Get A Failing Grade on Parity 

Beginning in October, bare-bones, short-term health plans that are exempt from critical coverage provisions of the Affordable Care Act (ACA), will become more widespread in the insurance market. A final rule issued this week by the Departments of Health and Human Services (HHS), Labor and Treasury would permit the sale of limited health coverage plans that expose consumers to more risks and potentially larger medical bills when seeking critical care. The National Council strongly opposes any moves that undermine the availability of comprehensive coverage, including mental health and addiction benefits offered at parity.

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The National Alliance on Mental Illness (NAMI) recently released a report “Mental Health Parity at Risk” highlighting disparities in health coverage for behavioral health services. Parity ensures that patients have access to health plans that cover mental health and substance use disorder treatment, in addition to medical/surgical services, and that they are not charged more for using such services. The report finds that parity was very weak prior to the passage of the Affordable Care Act’s (ACA) consumer protections, which limited consumers’ access to treatment. The report underscores how current efforts to weaken the individual insurance market could mean returning to a time when Americans with behavioral health conditions could be denied coverage or offered coverage that excludes services they need.

Read More on New Report Shows Mental Health/SUD Parity At Risk 

Last week, several federal agencies issued guidance to enhance the enforcement of the federal parity law, which requires that insurance coverage of mental health and addiction services be equal to medical/surgical health services. The new guidance is the result of requirements included in the 21st Century Cures Act to improve behavioral health coverage. The guidance released by Health and Human Services (HHS), Departments of Labor and Treasury is intended to help employers and insurers implement parity, improve the coordination of parity enforcement between the agencies and to provide Congress with recommendations for improving parity compliance moving forward.

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On Monday, July 31, the White House Commission on Combating Drug Addiction and the Opioid Crisis published its interim report. It included nine recommendations President Trump can take to combat the nation’s opioid crisis, to prevent deaths and provide more accessible and informed methods of treatment for opioid addiction. With 142 Americans dying every day from an opioid overdose, the Commission called on the President to declare a state of national emergency. Rumors indicate the President may make this declaration as early as Thursday (8/3) evening.

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On Wednesday, the House of Representatives overwhelmingly passed the 21st Century Cures Act – a medical research and innovation bill that includes important funding for addictions. The bill authorizes $1 billion over the next two years to address the opioid crisis, and would create and reauthorize a number of federal mental health grant programs. The Senate is set to consider the bill early next week.

Read More on Congress Reaches Deal on Opioid Funding, Mental Health 

Last week, the White House Mental Health and Substance Use Disorder Parity Task Force released its recommendations for improving the implementation of the federal parity law. The Task Force report details the Obama Administration’s parity implementation activities undertaken throughout the last eight years, outlines new resources available as of today, and offers a number of recommendations for future action.

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Last Friday, the House Energy and Commerce Health Subcommittee held an informational hearing examining the implementation and enforcement of federal mental health and addiction parity laws and regulations. This hearing is the culmination of conversations that took place during the debate of the Helping Families in Mental Health Crisis Act back in June. The Subcommittee engaged providers, behavioral health organizations, and consumers on the implementation of parity requirements, federal and state enforcement efforts, and consumer awareness and access to insurer coverage documents.

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As attention is gaining around parity and the implementation of the Mental Health Parity and Addiction Equality Act (MHPAEA), SAMHSA released a resource for states that provides guidance on best practices in parity enforcement. The guide utilized input from seven states and insurance commissioners who identified five primary components that they considered essential for implementation and monitoring of parity:

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Two weeks ago the NH Insurance Department released a new analytical report showing that in 2014 and 2015, private health insurance companies paid health providers less than Medicare rates for the most common services associated with treatment of substance use disorders. The study is a part of the Insurance Department’s broader focus on the substance use crisis in New Hampshire.

Read More on New Hampshire Study Finds Low Rates May Impede Access to Addiction Care 

On Wednesday, the House voted overwhelmingly to pass bipartisan legislation aimed at improving the nation’s mental health system. The Helping Families in Mental Health Crisis Act (H.R. 2646) – first introduced by Rep. Tim Murphy in 2013 – passed by a 422-2 vote and now awaits action from the Senate before heading to the White House. On the Senate side, a companion measure was approved earlier this year but has yet to receive consideration on the floor. HELP Committee Chairman Lamar Alexander (R-TN) says he is hopeful the Senate will take up that measure in September.

Read More on House Approves Mental Health Bill, Eyes Now Turn Towards Senate 

On Wednesday, June 15, the House Energy and Commerce Committee will convene a hearing to consider and vote on a revised version of the Helping Families in Mental Health Crisis Act (H.R. 2646), originally introduced by Rep. Tim Murphy (R-PA). The draft bill reflects a few changes pushed by Committee Chairman Fred Upton (R-MI), including codifying a limit on Medicaid coverage for inpatient mental health care at institutions for mental diseases (IMDs) – Per the final Medicaid managed care rule – and dropping language that would loosen Health Information Portability Accountability Act (HIPPA) restrictions.

Read More on House Committee to Consider, Vote on Mental Health Reform Bill 

On Friday, June 10, National Council President and CEO Linda Rosenberg will participate in a listening session with Secretary of Health and Human Services Sylvia Burwell and Director of the Office of National Drug Control Policy Michael Botticelli. The discussion will cover issues related to parity implementation and enforcement.

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On Monday, news broke that House Energy and Commerce Committee Chairman Fred Upton (R-MI) had begun circulating a revised draft of comprehensive mental health reform legislation. According to congressional staff familiar with the situation, the Chairman is pushing a modified bill including provisions from both Rep. Tim Murphy’s (R-PA) bill – Helping Families in Mental Health Crisis Act (H.R. 2646) and Rep. Gene Greene’s (D-TX) bill – Comprehensive Behavioral Health Reform and Recovery Act (H.R. 4435).

Read More on House Committee Circulates Compromise Mental Health Draft Bill, Vote Likely in June