Alaska lawmakers held a meeting last week to review legislation that would increase behavioral healthcare parity for Medicaid-covered services.
House Concurrent Resolution 9 and House Bill 361, both sponsored by Rep. Mike Prax (R-North Pole), seek parity in coverage of benefits for Medicaid mental health and substance use disorder (SUD) treatments in Alaska.
Riley Nye, a legislative aide for Prax, discussed the legislation at a House Health and Social Services Committee meeting.
“[Parity] will ensure that patients are able to transition between physical and behavioral healthcare services smoothly, and more time will be spent treating patients rather than completing administrative tasks,” Nye said.
Nye highlighted the Mental Health Parity and Addiction Equity Act (MHPAEA), a federal law passed in 2008 that prevents certain insurance carriers from providing less favorable benefits for behavioral healthcare services compared to physical healthcare services. The law only applies to private insurance carriers.
In 2016, the Centers for Medicaid and Medicare Services (CMS) adopted rules that require certain managed care plans to comply with parity laws under MHPAEA.
Managed care plans that are not part of a Medicaid managed care organization or alternative benefits plan that are offered on a fee-for-service basis are not held to the same parity standards. As a fee-for-service state, Alaska is exempt from federal parity standards.
“This exemption has led to ineffective payment rates for providers and overbearing regulation requirements that further erode access to lifesaving treatments. While commercial insurers are required to meet federal parity requirements, HB 361 seeks the same access to behavioral health services for Medicaid beneficiaries.”
— Nye
The purpose of HCR 9 is to officially encourage and prioritize parity in the state. If passed, HB361 would enact actual regulations that would align with HCR 9’s sentiment.
John Solomon, CEO of the Alaska Behavioral Health Association (ABHA), highlighted the differences between patients’ experiences when accessing care for their physical health versus their mental health due to lack of parity.
Solomon said if a person goes to a community health center for a physical problem, they fill out intake forms, get a brief assessment of their symptoms, receive immediate treatment, and develop an ongoing plan (when necessary) in just one appointment.
When a person visits a community behavioral health center for a psychiatric problem, Solomon said each step before treatment—intake, assessment and evaluation, and developing a treatment plan—can often require its own appointment to complete due to documentation regulations required in publicly-funded behavioral healthcare.
“There are a lot of documentation standards that are baked into [behavioral healthcare] regulations that are different from the [physical] healthcare documentation standards. Different isn’t bad; it’s just [bad] when you have one page versus 100 pages.”
— Solomon
Solomon presented the differing standards to the committee, noting that providers at community behavioral health clinics often have to fill out more than 100 pages of documentation per patient in order to meet state and federal regulations.
Conversely, providers at federally qualified health centers and other Medicaid-covered physical health clinics have to complete just one page of documentation per patient, Solomon said.
Solomon said the state’s current publicly-funded behavioral healthcare system functions out of a fear of audits due to the amount of paperwork providers must complete. He said the system should be built on accreditation, best practices, and clinical judgment instead, which would be similar to the physical healthcare process.
“This isn’t saying we want to get rid of the standards that [the regulations] were built on,” Solomon said. “[The legislation] is just taking some of that out of regulations so it becomes clinical. We’re building on clinical judgment, clinical best practice.”
Lance Johnson, chief operations officer at ABHA, said lack of parity causes problems in the broader healthcare system, as well as the justice system.
“Without parity, we’ll continue to see not only the emergency rooms get jammed up—because it’s easier for people to get behavioral healthcare there—but we’re also going to see our correctional facilities jammed up [with] people who have gone untreated,” Johnson said.
HCR 9 has been referred to the House Rules Committee and HB 361 awaits further assignment within the legislature.