Lobbies Seek Last-Minute BBB Tweak Allowing Appeals Of Mental Parity Fines

Inside Health Policy

November 18, 2021 6:34 pm

Stakeholders upset by the Build Back Better package’s inclusion of civil monetary penalties for violations of the mental health parity law are pressing congressional leadership to make last-minute changes that would give firms compliance assistance and appeals rights if the provision moves forward. The letter comes a day after the Congressional Budget Office said granting the Department of Labor authority to enforce the penalties would raise $35 million from 2022 to 2031, a number a source says was expected, and as the House prepares to vote on the BBB package as soon as Thursday night.

In a letter out Thursday (Nov. 18), eight groups representing large employers, insurers and behavioral health providers told House and Senate leaders from both parties they are committed to providing quality treatment for mental health and substance abuse and are working to comply with current requirements, but they want lawmakers to tweak the BBB final language to include due process, compliance assistance and appeals rights.

They stress that after passage of the Consolidated Appropriations Act and the release of mental health parity guidance, stakeholders made a good faith effort to comply with new requirements. Under the CAA, individual and group health plans that offer mental health/substance abuse and medical/surgical coverage and impose non-quantitative treatment limitations (NQTLs) on the mental health/substance abuse benefits must prepare a comparative analysis of the design and application of the NQTLs.

“However, despite extensive good faith efforts to comply, our members have reported that upon submitting analyses, DOL staff sent back dozens of questions and requests for substantially more documentation,” the groups say. “The public and private sectors are committed to working together to improve MH/SUD access and are taking clear steps to comply. We ask that you now turn your focus toward ensuring that the federal agencies that enforce MHPAEA support compliance with the CAA requirements.”

Providing more tools and templates that include examples of complex benefit analysis would be helpful as would releasing the de-identified examples of mental health parity violations, which is required under the CAA, they add.

If Congress does opt to move forward with BBB provision, the groups ask that lawmakers amend the language to ensure that due process, compliance assistance and the right to appeal is offered. The changes they seek would:

  • “Identify the parties that can originate complaints to those impacted by the provisions, including participants, beneficiaries, and state regulators.
  • “Allow for the civil monetary penalties if the parties have not implemented a corrective action plan.
  • “Create administrative and judicial review of the process to give plans, issuers, and administrators due process.”

The letter also includes legislative language with the proposed alterations.

 “Penalties won’t improve mental health coverage or care. At best, they will take money out of plan funds, punishing employers who make mistakes interpreting complicated rules. At worst, they will stifle innovation and cause employers to use more cookie cutter plan designs. We can do better than this for patients,” says James Gelfand, vice president for health policy at the ERISA Industry Committee (ERIC), one of the lobbies that signed Thursday’s letter.

Other groups on the letter include American Benefits Council, Association for Behavioral Health and Wellness, AHIP, Blue Cross Blue Shield Association, Business Group on Health,
Business RoundTable and National Retail Federation.