It has been ten years since Behavioral Health Parity became federal law.
Through Timothy’s Law in New York State and the Federal Parity Benefit,
many people in commercial insurance plans, Medicaid Managed Care and CHIP
have been able to get behavioral health benefits equivalent to medical and
surgical benefits. This has saved millions of dollars and played a major
role in combatting stigma and enhancing worker productivity for both
individuals with behavioral health needs and their loved ones. It has also
in no way broken the bank as many warned a decade ago. Benefit increases to
rates through coverage of behavioral health have been minimal.

However, there remains some serious issues with parity. Part of the parity
law consisted of what is known as non-quantitative treatment limits. These
are the non- numerical parts of parity that are not as easy to track or
quantify. Examples include medical necessity, preauthorization, utilization
review, network standards, etc. As a result, both across New York and the
rest of the country, there have been many times when people were unable to
secure parity benefits because of the lack of quality standards around
measuring non-quantitative treatment limits. This has been used both as an
excuse and a rational for denying benefits. Examples include using medical
necessity as a way to reject or limit benefits, providing pre-authorization
requirements around medications in a formulary or using utilization review
as a means to deny benefits.

Advocates in New York are doing something about this. Through the
leadership of the Legal Action Center (LAC), there is a new website about
parity entitled www.parityat10.org. It is meant to shed light on the
problem in parity implementation. In addition, LAC helped lead the fight
for funding in New York to create an ombudsman whose role will be to help
respond to complaints from individuals who are denied parity benefits.
Also, this year there has been legislation led by the Psychiatric
Association and NASW that would both raise awareness and enhance
accountability regarding full parity benefits. We are urging the Governor
to sign this legislation.

Last week, a group of advocates met with the Governor’s Office and State
Leadership from OMH, OASAS, Division of Budget, Department of Financial
Services and Department of Health about this specific issue. Compared to
other states, New York is way ahead of the curve in responding to the
concerns that we laid out. They are mindful of how entities skirt the
parity law and are utilizing resources to provide greater awareness and
greater enforcement of the law. We look forward to continued discussion.
This is way too important an issue to be left unaddressed.

Please feel free to reach out with any questions.

Glenn

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