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.”