Key senators released draft legislation which, if signed into law, will crack down on Medicare Advantage (MA) plans that don’t offer accurate provider directories, a bid to improve mental health pay parity.
Leaders of the Senate Finance Committee released a discussion draft Thursday (PDF) outlining efforts to improve pay parity between behavioral and mental health. The draft is part of a larger package by the committee to address mental health, but the panel is running out of time to get a package through before the end of the year.
“Too often the notion of mental health parity falls short of reality,” said Ron Wyden, D-Oregon, the committee’s chairman. “These policies represent the first step towards addressing the mental health parity and ghost network challenges that I intend to build on in the coming months.”
A key part of the draft is to codify a series of existing requirements from the Centers for Medicare & Medicaid Services for MA plans starting in 2025. The requirements would call for plans to include up-to-date contact information for providers and whether a provider is accepting any new patients.
The plan must update a provider’s in-network status within two days. The discussion draft also calls for plan provider directories to be posted on a public website.
The goal of the legislation is to address part of the issue of “ghost networks,” where plan holders are unable to gain access to mental health providers because of inaccurate directories. The draft also hopes to codify other regulations that call for Medicaid managed care organizations to keep their provider directories updated and say whether the providers are accepting new patients.
Other parts of the discussion draft include:
- A Government Accountability Office (GAO) study on the differences between enrollee cost-sharing and utilization management for MA between mental health and non-mental health benefits. The study would also compare the cost-sharing to fee-for-service Medicare
- Another GAO report that compares payment rates in Medicaid to behavioral health services and medical or surgical services
- New guidance from Medicare to providers detailing the extent to which Medicare beneficiaries suffering from substance use disorder can get partial hospitalization program services
While the Affordable Care Act mandated parity between mental and behavioral health, there have been complaints that parity remains elusive.
The discussion draft is the fifth released by the committee in the nearly yearlong effort. Other drafts have focused on improving the mental health workforce and improving youth mental health.
It remains unclear whether the committee will be able to get the package through this year. Some healthcare groups are hoping to include major priorities such as a delay to provider cuts in a must-pass government spending package that has to get approved by Dec. 15 to avoid a government shutdown.