The U.S. Senate focused on mental health legislation last week, introducing one new bill and releasing a draft of another, both of which would have an impact on workplace health plans.
If enacted, the Behavioral Health Coverage Transparency Act of 2016, introduced by Senator Elizabeth Warren, would require group health plans and insurance issuers to disclose to federal regulators how they are making mental health parity decisions, and the rate and reasons for denials of mental health claims.
It would also require the regulators to conduct random audits of health plans and to make the results of those audits publicly available. Additionally, the bill establishes a Consumer Parity Unit that gives consumers a single place to get information about their rights and to submit complaints with assurance of timely responses.
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To help improve transparency regarding the compliance of state-regulated insurance plans with parity laws, the Act would also require each state health insurance commissioner to collect information from group health plans and insurers that offer coverage in their state. Specifically, they would have oversight responsibilities for compliance with the federal mental health parity rules.
States would have to submit annual reports to federal regulators that compare financial requirements and treatment limitations imposed by each plan and insurer for mental health and substance use disorder services, on one hand, and for medical and surgical benefits on the other.
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“The law is clear: Americans have the right to equal health care coverage for physical and mental illness, but far too many families face far too many denials from their insurance companies,” said Senator Warren in a news release. “The Behavioral Health Coverage Transparency Act will help strengthen accountability for insurers and give consumers better tools to get information and submit complaints.”
A draft of a bipartisan bill, Mental Health Reform Act of 2016, was also released last week by the Senate Health, Education, Labour and Pensions (HELP) Committee. It would encourage “better enforcement of existing mental health parity laws.”
The Department of Health and Human Services would issue regulations to assist group health plans and insurers with satisfying the mental health and substance use disorder parity requirements, including those for non-quantitative treatment limitations. A key enforcement provision in the bill provides that if a group health plan or health insurance issuer has five or more findings of non-compliance with the mental health parity rules, a mandatory audit would be conducted the following year.
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“A focus on mental health legislation is expected to continue and gain traction,” said Xerox HR Services, in a news release. “With both bipartisan and bicameral support, and a notable desire among many members of both chambers to further strengthen access and quality of mental health care, legislation may be enacted during the current Congress.
“As such, employers are encouraged to review existing policies and practices to evaluate compliance with mental health coverage and parity rules.”
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