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Parity coalition pushes on in warning of consequences to Fla. insurance changes

May 3, 2012
by Gary A. Enos, Editor
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Advocates say Blue Cross management of provider network violates intent of parity law

It is an effort they have carried on for months, approaching a year, and there remain few obvious signs of progress as addiction and mental health treatment advocates highlight what they see as injustices in a leading Florida insurer’s new policies affecting substance abuse and mental health coverage.

The co-chairs of the Parity Implementation Coalition, a broad-based alliance of addiction and mental health organizations that includes nationally prominent addiction treatment centers, believe Blue Cross Blue Shield of Florida’s dismantling and subsequent restructuring of its behavioral health provider network under reduced reimbursement rates is starting to reverberate outside the state.

“When you look at comparable rates, it is becoming a race to the bottom,” with word of other insurers across the country imposing or considering provider rate cuts, says Irwin (Sam) Muszynski, director of the American Psychiatric Association’s (APA’s) Office of Healthcare Systems and Financing.

Muszynski says the situation in Florida caught advocates’ attention last summer when Blue Cross Blue Shield informed providers by mail that it was terminating contracts and that a newly formed network would be overseen by carve-out entity New Directions Behavioral Health. Muszynski says the provider contracts now in place result in cuts of 15 to 40% in reimbursement.

But Muszynski and Parity Implementation Coalition co-chair Carol McDaid, principal of Capitol Decisions, Inc., say the changes that took effect in December and January hit addiction and mental health providers harder than their counterparts in other areas of healthcare. In addition, they say, while providers working in settings such as university hospitals or multispecialty group practices appear to have been spared from any changes, the same cannot be said for clinicians working, for example, in private addiction treatment facilities.

“We viewed this as pretty egregious—we wanted to know if Blue Cross met the requirements of [the federal parity law’s] interim final rule,” says Muszynski. Under the parity law, insurers may not impose differential standards for admission to a provider network for behavioral health providers, as this could result in provider attrition and therefore a gap in addiction and mental health services for consumers.

“We can’t think of a clinically appropriate standard to explain differential reimbursement rates,” Muszynski says. “We have firsthand knowledge that no one on the med/surg side got a fee cut.”

Florida officials have told advocates there is nothing they can do to respond to Blue Cross’s actions in terms of possible violations of a federal law. At the same time, federal agencies such as the Centers for Medicare & Medicaid Services (CMS) have not reacted publicly to the matter, but advocates see some reason for hope that Blue Cross’s actions are being examined behind the scenes.

“We get the sense that there is some investigating going on in Florida,” McDaid says. Federal officials could be investigating possible violations of the parity law, perhaps in Florida and perhaps elsewhere.

It is likely that the Blue Cross issue will serve as a signature topic in a parity field hearing to be held in Delray Beach, Fla., in October. These hearings, involving parity legislative champions and former House members Patrick Kennedy and Jim Ramstad, gather testimony on parity implementation and enforcement from numerous sectors of the community, including providers, consumers and the business community.

Upcoming events will occur June 26 in Chevy Chase, Md., July 17 in Minneapolis and Aug. 6 in Chicago. For more information about the hearings and the Parity Implementation Coalition, visit http://parityispersonal.org.

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