Sen. Wyden Asks Federal Watchdog to Investigate Mental Health Services Contracts Among Insurance Companies

WASHINGTON, May 29 -- Sen. Ron Wyden, D-Oregon, ranking Democratic member of the Senate Finance Committee, issued the following news:

Senate Finance Committee Ranking Member Ron Wyden, D-Ore., asked federal watchdogs to review the prevalence and consequences of insurance companies subcontracting mental health service coverage to a different insurance company. In a letter to the Government Accountability Office (GAO), Wyden asked the agency to review whether plans that subcontract mental health coverage experience differences in treatment limits or their ability to meet federal mental health parity requirements.

"The COVID-19 pandemic has exposed shortfalls across the health care system, and mental health care is no exception," Wyden said. "Millions of Americans are struggling with the consequences of job loss, isolation and other difficulties associated with this crisis. I've asked GAO to look at this issue to ensure all insurance plans that cover mental health services are meeting their legal requirements and covering this critical care for those who need it."

Wyden's request to GAO comes as the COVID-19 pandemic has spotlighted the need for adequate mental health care. More than half of all Americans have reported that the crisis has taken a toll on their mental health, with one in five reporting it has had a "major impact." There have also been dramatic increases in usage of mental health hotlines and online services.

The letter calls for the federal watchdog to examine the role of behavioral health service organizations in the administration of mental health care. These organizations are subcontracted by health plans across Medicaid, Medicare Advantage, employer-sponsored insurance and the commercial market to oversee and pay for a person's mental health care services. Wyden received reports from health care providers that these organizations may be more likely to deny coverage or refuse adequate payment for services.

The full letter can be found here: https://www.finance.senate.gov/imo/media/doc/052720%20GAO%20Mental%20Health%20Parity%20Letter%20final.pdf

May 28, 2020 The Honorable Gene Dodaro Comptroller General of the United States Government Accountability Office 441 G Street, N.W. Washington, D.C. 20548 Dear Mr. Dodaro, The COVID-19 pandemic is taking an unprecedented toll on the mental health of Americans and exacerbating existing barriers to mental health parity. Before the COVID-19 pandemic ravaged the Nation's health care system, far too many people were denied coverage for mental health care services or unable to find a mental health care provider covered by their insurance. Today, over half of adults in the United States have reported that their mental health has been negatively impacted due to worry and stress over the COVID-19 pandemic.1 Social distancing and business and school closures, though necessary to slow the spread of COVID-19 and save lives, have exposed many people to situations that are linked to poor mental health outcomes, like isolation and job loss. Doctors, nurses, and other frontline workers are also at an increased risk for developing mental health conditions, including post-traumatic stress syndrome. In April, texts to a federal government mental health hotline increased over tenfold compared to the same month last year.2 While some mental health care providers are pivoting to rely on telemedicine during social distancing, not all are able to do so leaving some patients with nowhere else to turn. Increases in unemployment due to the pandemic have also placed increased pressure on essential health care programs like Medicaid - the primary payer of behavioral health care services in the United States. In Oregon, 23,000 individuals enrolled in the state's Medicaid program in the month of March alone with thousands more signing up for coverage in April and May. Such pressures emphasize the need to ensure access to robust, quality mental health care services and full mental health parity across all payers and programs in Oregon and across the United States. In light of COVID-19, the challenges that providers and patients alike have faced in improving behavioral health care in this country have only intensified. In recent discussions with Oregon's sole academic medical center, it came to my attention that Oregon Health and Sciences University (OHSU) had documented the tactics and practices plans were using to either deny coverage or refuse adequate payment for critical mental health care. Examples range from the rampant use of prior authorizations to blanket denials, and these practices were particularly used when patients were covered, unbeknownst to them, by plans that "carved out" behavioral health care services.

I am pleased to hear that, as the Government Accountability Office (GAO) conducts its oversight of the federal response to the COVID-19 pandemic and reporting requirements under the CARES Act, it plans to examine the effects of the COVID-19 pandemic on the demand for and delivery of mental health care services. In addition to this work, and given OHSU's experience that appears to be increasing, I request that GAO examine what is known about the role of behavioral health service organizations that many Medicaid, Medicare Advantage, employer-sponsored insurance, and commercial health plans contract with for their coverage of mental health care services in regards to the delivery of mental health care services meeting federal parity requirements. I am therefore requesting that GAO include the following questions in their priority COVID-19 oversight and respond to this request as quickly as possible.

1)What protocols do health plans that contract with behavioral health service organizationsuse to ensure those contracted services meet the statutory requirements of mental healthparity? How does compliance with federal mental health parity law differ across plansthat contract these services out versus those that do not? For example, to what extent doregulators, providers, or consumers and enrollees report differences, if any, in how non-quantitative treatment limits, such as prior authorization and provider networkavailability, are applied among health plans with mental health coverage carve-outs fromplans that do not carve-out this coverage?

2)What tools do federal and state regulators use to identify any patterns of compliance ornoncompliance that may occur across different Medicaid, Medicare Advantage,employer-sponsored insurance or commercial health plans using the same subcontractedor standalone behavioral health service organizations? For example, how do federal andstate requirements and industry practices among health plans and subcontracted orstandalone behavioral health service organizations address challenges in continuity ofcare and consistency in application of mental health parity for people with changes intheir sources of health coverage?

3)How are federal and state regulators ensuring that health plans are meeting mental healthparity requirements if there are changes in availability of providers in plans' networksdue to COVID-19?

4)With a documented increase in the use of telemedicine for the treatment and managementof behavioral health conditions, what tools are plans using to ensure compliance withmental health parity requirements? To the extent that plans have been identified asfailing to meet mental health parity requirements prior to the pandemic, what oversight isoccurring to ensure compliance?

Thank you for your urgent attention to this matter. Your efforts to conduct oversight of the effects of COVID-19 on the behavioral health care delivery system are crucial to ensuring patients are able to access needed services during this critical time.

Sincerely,

Senator Ron Wyden

* * *

Footnote:

1 https://www.kff.org/report-section/kff-health-tracking-poll-late-april-2020-economic-and-mental-health-impacts-of-coronavirus/ 2 https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2020/05/04/the-health-202-texts-to-federal-government-mental-health-hotline-up-roughly-1-000-percent/5eaae16c602ff15fb0021568/?itid=ap_paigewinfield%20cunningham&itid=lk_inline_manual_12