Mental Health Parity & Addiction Equity Act & Medicaid -- Final Rule Just Issued  (we have included claims based on these laws in our lawsuit)

Key Provisions for Medicaid Managed Care Organizations.  

Under the final rule, states that have contracts with managed care organizations are required to meet the parity requirements regarding financial and treatment limitations consistent with the regulation applicable to private insurers. States will include the cost of providing additional services or removing treatment limitations in their capitation rate methodology for affected managed care plans.

By allowing changes to the managed care rate setting process, the rule also provides each state with flexibility to enable Medicaid managed care organizations to fully comply with the rule by including additional costs necessary to include extra services or remove treatment limits without changing the state’s non-alternative benefit plans and state plan.

In addition, the final rule requires managed care entities to make available upon request to beneficiaries and contracting providers the criteria for medical necessity determinations with respect to mental health and substance use disorder benefits.

​The rule also directs managed care plans to make available to the enrollee the reason for any denial of reimbursement or payment for services with respect to mental health and substance use disorder benefits.

Medicaid Fact Sheet


              See Also:  "Feds extend behavioral health parity to Medicaid, CHIP"  [of course, they had to if they going to comply with the law -- Editor's Note]
   http://www.clinicalpsychiatrynews.com/specialty-focus/addiction-medicine/single-article-page/feds-extend-behavioral-health-parity-to-medicaid-chip/4f5ab0b8b893f18a96525cc14d7d62fe.html  

Vox.com

 Some Say Enforcement of the Mental Health Parity & Addiction Equity Act is a "Joke"

(we'll just say that if we had some real enforcement of the ADA, the MHPAEA, etc.  there would be no need for our Complaint)
               " When it passed in 2008, the federal mental health parity law was supposed to be a major achievement for Americans with mental illnesses.
Historically, people seeking mental health care often faced higher copayments and deductibles and more limited access to treatment than those with other conditions.

​              "The parity law was intended to fix that, ensuring they could get the treatment they needed with the same ease as patients with cancer, diabetes, or any other ailment. Though some states already had their own parity laws on the books, there were serious gaps in the protections they offered.

               "At the time, Sen. Edward Kennedy (D-MA) called the law "historic," and praised his colleagues for finally ending "the senseless discrimination in health insurance coverage that plagues persons living with mental illness."

               "But seven years after the federal law passed, many families say it has fallen far short of expectations. Researchers, attorneys, and other critics say patients with mental illnesses continue to face discrimination — largely because insurers have continued to limit treatment through strategies that are subtle and difficult to track.
.  .  .

                "Enforcement of parity law, meanwhile, has been relatively lax. So far, the US government has not taken a single public enforcement action against an insurer or employer for violating the federal law. And only a handful of states have dug into whether insurers are complying with their parity laws.

                "Henry Harbin, Maryland's former mental health director who now consults on the issue, said insurers are taking advantage of the minimal oversight. "They can micromanage care down to almost nothing," he says.

"The enforcement in this area is a joke."

http://www.vox.com/2015/8/3/9069643/mental-health-parity-lawsuits