Recent Reports Spotlighting Key ACA Reforms Highlight the Need to Optimize Mental Health Parity Coverage and Electronic Health Record Usage

Wednesday, April 29, 2015
Michael Gomes

The Affordable Care Act (ACA) promised many improvements to health care access, quality and technology. Unfortunately, a few of these optimistic promises may be falling short in reality. Specifically, we’ll examine the lack of parity in ACA plans, as well as the excessive fees associated with EHR implementation.

ACA Offers Many Plans Lacking Mental Health Parity

While the ACA and The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) sought to make health coverage more accessible and affordable, a new study recently found that one-quarter of ACA plans go against the federal parity. The consumer-reported information suggests that “it [is] nearly impossible for consumers to find the best plan to cover their mental health needs.”

Specifically, the study noted financial disparities, including different co-pays or deductibles, for mental health and substance abuse disorder (MH/SUD) treatments and services as well as stricter requirements for “prior authorizations” from insurers before a patient could seek mental health services.

Some health plans, however, are pushing back. Clare Krusing, spokeswoman for America's Health Insurance Plans, stated in USA Today that the rules contained some important changes affecting plan design that were only required for insurance plan years that started on or after July 1, 2014. She further said that it's unfair to say a plan doesn't offer mental health parity based only on what consumers see before buying the plans.

In the same article, Cigna spokesman Jon Sandberg said that, in the eight states that it sells on the Exchanges, Cigna doesn’t require prior authorization for outpatient mental health treatments, and that cost-sharing levels for MH/SUD are the same as cost-sharing levels for other specialists. Cigna CEO David Cordani added, “Mental and physical health are inextricably linked, so benefits covering physical health may extend to some aspects of mental health. For example, the majority of antidepressants are prescribed by primary care doctors.”

Patrick Kennedy, founder of the Kennedy Forum and sponsor of the MHPAEA, stated in the article that “he was shocked that the printed material examined by researchers openly described differences in mental and physical health coverage. The Obama administration should require all insurance plans to disclose how they approve both medical and psychiatric claims, he says, adding that plans wouldn't be able to discriminate if those processes were open for public inspection.”

Last week, we discussed a recently proposed bill that seeks to offer parity in Medicaid managed care plans.

Data Fees Slow Health Care Reform

In addition to implementing mental health parity, the ACA also urged doctors and hospitals to move to electronic health records (EHRs) by offering $30 billion to digitize their health records with the goal of improving the quality of patient care and bringing down costs. Despite the obvious benefits in EHRs, according to news reports, many health care software vendors are road-blocking the necessary process by asking for thousands of dollars to unlock data and make it shareable.

Although most doctors and hospitals have already switched to EHRs, the information often gets stuck in computers run by hundreds of competing software companies with “incompatible products and scant incentive to make them compatible.” And, according to one example in the article, doctors usually pay a $10,000 set up fee as well as a $5,000-50,000 fee for to set up connections that allow the transmission of information. Sometimes, additional fees are collected each time a doctor sends or receives data.

Although congressional Republicans are often hesitant to intervene on business practices, many members of the GOP are considering sanctions on the software vendors.

“Interoperability is what makes an EHR useful,” Rep. Michael Burgess (R-Texas), a physician who leads the House Energy and Commerce trade subcommittee and is drawing up a bill to enforce data sharing, was quoted as saying in Politico. “It’s unfair that practitioners have to spend money on connections they thought were part of the EHR when they bought it.”

Unfortunately, as Politico noted, the additional costs were not anticipated during the bipartisan congressional push to create the federal incentive program. As a result, “The expense is now imperiling the broad efforts to reform health care and adding to the host of technical obstacles that already hamper the flow of information.”

As doctors race to meet the latest stages of the EHR incentive program, thereby meeting federal requirements, EHR vendors have seen incentive payments begin to dry up, thus making them rely on consulting fees and contracts. The Electronic Health Records Association, which represents most vendors, did not comment on the pricing policies, but stated that “the connections were expensive because of the lack of common computer-code standards across the hundreds of EHR manufacturers.”

Stay Tuned

Stay tuned as we continued to report on mental health parity implementation and the road to digital health records, as well as any other issues affecting Brokers.

The views expressed in this post do not necessarily reflect the official policy, position, or opinions of BenefitMall. This update is provided for informational purposes. Please consult with a licensed accountant or attorney regarding any legal and tax matters discussed herein.