RISE summarizes recent headlines in regulatory news.
Feds: Health plans fail to deliver on mental health parity
A new report by the Departments of Labor, Health and Human Services and the Treasury suggests that health plans and health insurance issuers fail to deliver parity for mental health and substance-use disorder benefits to those they cover. For example, an issuer covers nutritional counseling for medical conditions like diabetes but not for mental health conditions such as anorexia nervosa, bulimia nervosa, and binge-eating disorder.
"The report's findings clearly indicate that health plans and insurance companies are falling short of providing parity in mental health and substance use disorder benefits, at a time when those benefits are needed like never before," U.S. Secretary of Labor Marty Walsh said in the report announcement. "The pandemic is having a negative impact on the mental health of people in the U.S. and driving a rise in substance use. As a person in recovery, I know firsthand how important access to mental health and substance-use disorder treatment is. Enforcement of this law is a top priority for the Department of Labor and an objective I take personally."
The Department of Labor's Employee Benefits Security Administration said it is taking steps to enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) and is using its full authority to facilitate access to mental health and substance use disorder treatment. HHS through the Centers for Medicare & Medicaid Services (CMS) has also increased its MHPAEA enforcement activities in the individual and fully insured group markets in states where CMS has enforcement authority over non-federal governmental plans in all states.
CMS issued 15 letters between May and November 2021 to issuers in states where the agency has direct enforcement authority over MHPAEA (Texas, Missouri, and Wyoming) and to non-federal governmental plan sponsors in those and other states, according to the report.
The report also pointed to its $15.6 million settlement with United Behavioral Health and United Healthcare Insurance Co. and Oxford Health Insurance Inc. According to the settlement announcement, United reduced reimbursement rates for out-of-network mental health services, thereby overcharging participants for those services, and flagged participants undergoing mental health treatments for a utilization review, resulting in many denials of payment for those services. The allegations go back to at least 2013.
For more information, click here for a fact sheet on MHPAEA enforcement.
CMS will make nursing home staffing data available to improve quality of care
The information will be added to the Care Compare website in January 2022 and used in the Nursing Home Five Star Quality Rating System in July 2022.
Having access to this information will help consumers understand more about each nursing home facility’s staffing environment and choose a facility that provides the highest quality of care that best meets the health care needs of their loved one, according to CMS.
“CMS has long identified staffing as a vital component of a nursing home's ability to provide quality care, and CMS has used staffing data to more accurately and effectively gauge its impact on quality of care in nursing homes," CMS Administrator Chiquita Brooks-LaSure said in the announcement. "The COVID-19 pandemic has highlighted the importance of staffing for the well-being of residents and it's more important now than ever that CMS release any information related to staffing that can improve quality. Residents and their families will also find this information valuable as they consider a nursing home for themselves or a loved one.”
For more information, click here for the CMS guidance memo.
OSHA ceases emergency enforcement of COVID-19 mandate for large employers—for now
The Occupational Safety and Health Administration this week withdrew its emergency temporary standards that it instituted in November to protect unvaccinated employees of large employers (100 or more employees) from the risk of contracting COVID–19 by strongly encouraging vaccination.
The decision to withdraw enforcement of the emergency mandate was made in the wake of a U.S. Supreme Court decision to stop the enforcement while appeals are pending at lower courts. The requirement for health workers still stands.
The vaccination and testing emergency temporary standard required employers to develop, implement, and enforce a mandatory COVID–19 vaccination policy, with an exception for employers that instead adopted a policy requiring employees to either get vaccinated or elect to undergo regular COVID–19 testing and wear a face covering at work in lieu of vaccination.
OSHA said it is withdrawing the enforceable emergency temporary standard but not withdrawing it as a proposed rule.
“Notwithstanding the withdrawal of the Vaccination and Testing ETS, OSHA continues to strongly encourage the vaccination of workers against the continuing dangers posed by COVID-19 in the workplace,” OSHA wrote in the filing.
Feds release additional $2B in provider relief fund payments to health care providers
The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced this week it will make more than $2 billion in Provider Relief Fund (PRF) Phase 4 General Distribution payments to more than 7,600 providers across the country.
These payments come in the wake of $9 billion in funding that was already released by HHS in December 2021. So far nearly $11 billion in PRF Phase 4 payments have been distributed to more than 74,000 providers in all 50 states, Washington D.C., and five territories. This is in addition to HRSA’s distribution of American Rescue Plan (ARP) Rural payments totaling nearly $7.5 billion in funding to more than 43,000 providers in December 2021.
“Provider Relief Fund payments have served as a lifeline for our nation’s heroic health care providers throughout the pandemic, helping them to continue to recruit and retain staff and deliver care to their communities,” Health and Human Services Secretary Xavier Becerra said in the announcement.
Indeed, the Provider Relief Fund payments have been critical in helping health care providers prevent, prepare for, and respond to coronavirus. Providers have used the funds to remain in operation and to continue supporting patient care by covering a variety of costs including personnel, recruitment and retention initiatives, medical supplies, information technology, and many other functions, according to HHS.
Phase 4 payments have an increased focus on equity, including reimbursing a higher percentage of losses for smaller providers and incorporating “bonus” payments for providers who serve Medicaid, Children's Health Insurance Program (CHIP), and Medicare beneficiaries. Approximately 82 percent of all Phase 4 applications have now been processed.
ONC seeks feedback on electronic prior authorization standards
The U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) has released a Request for Information seeking input from the public on electronic prior authorization standards, implementation specifications, and certification criteria that could be adopted within the ONC Health IT Certification Program (Certification Program). ONC may use the responses to inform potential future rulemaking to better enable providers to interact with health care plans and other payers for the automated, electronic completion of prior authorization tasks. Ultimately, such electronic processes will serve to ease the burden of prior authorization tasks on patients, providers, and payers.
Payers establish prior authorization requirements to help control costs and ensure payment accuracy by verifying that an item or service is medically necessary, meets coverage criteria, and is consistent with standards of care. However, the processes often become an administrative burden and have been associated with health care provider burnout and patient frustration, sometimes posing a health risk to patients when it delays their care.
ONC is requesting public comment on how the Certification Program can build on existing efforts to reduce the burden of prior authorization tasks. It also wants feedback on anticipated benefits and burdens of any updates to the Certification Program for providers, health IT developers, and patients.
“Supporting the needs of clinicians and improving patient care are key priorities for ONC,” Elise Sweeney Anthony, executive director, Office of Policy, said in an announcement. “We’re eager to hear from the public about prior authorization and ways to bridge the gap between administrative and clinical data so that clinicians have more time to focus on patient care and patients have a better experience with the healthcare system.”
Click here for more information on how to provide written or electronic comments to ONC. Comments must be submitted by March 25.