Promoting Access To Safe, Appropriate, Cost-Effective Behavioral Health Care

by AHIP

February 9, 2017

Key Takeaways

bhhealthplanartboard-02Health plans have worked diligently and successfully to ensure compliance with requirements of the Mental Health Parity and Addiction Equity Act (MHPAEA).

bhhealthplanartboard-04Health plans have adopted a variety of medical management tools that are used across both medical/surgical and mental health/substance use disorder benefits to help promote access to safe, appropriate, and cost-effective health care.

bhhealthplanartboard-03The value of medical management, long recognized by health plans and employers in the private sector, has also been affirmed in federal regulations and guidance.


Background

Health plans have worked diligently to ensure compliance with requirements of the Mental Health Parity and Addiction Equity Act (MHPAEA). Health plans have worked with clinical and administrative personnel across medical and behavioral departments to promote understanding, implementation, and compliance with the protections established by the parity rules – and they have made great progress. A 2013 report prepared for the U.S. Department of Health and Human Services (HHS) found “employers and health plans have made substantial changes to their plan designs in order to comply with MHPAEA.”

While much of the focus has been on compliance with financial requirements and quantitative treatment limitations, an equally important aspect of parity relates to non-quantifiable treatment limitations (NQTLs), which includes medical management. Health plans use medical management for medical/surgical benefits, as well as for mental health/substance use disorder (MH/SUD) benefits to help promote access to safe, appropriate, and cost-effective health care.