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Author: emorris

Mental Health Parity Really Does Mean Equal Benefits

In Danny P. v. Catholic Health Initiatives, 891 F.3d 1155 (9th Cir. 2018), the Ninth Circuit clarified the full extent of the “parity” required in the federal mental health parity law1 which has been in place since 2008. The Case In Danny P., the Ninth Circuit held that a particular group health plan (the Catholic Health Initiatives Medical Plan—Blue Cross Blue Shield) was prohibited from denying the same or equivalent room and board coverage in behavioral health facilities that it provided in non-behavioral health facilities, overturning the district court’s decision in favor of the plan.  Specifically, the Court held the plan could not be permitted to deny inpatient room board and costs at a behavioral health inpatient residential treatment facility while simultaneously allowing coverage for non-behavioral health (medical and surgical) inpatient room and board costs at a skilled nursing facility. The plan at issue was a self-funded group health benefit plan covering Catholic Health Initiatives employees and their dependents, and provided for coverage of “mental health services,” bed, board, and general nursing care, ancillary services provided at skilled nursing facilities, and also provided coverage for residential treatment facilities (licensed facilities that deal with illnesses affecting mental health). The health insurance plan here was trying to limit payments for behavioral health residential services. Many plans attempt to limit residential behavioral health services because they are much more costly than the...

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May Highlights: National Healthcare Law News

-Earlier this month, on May 7, 2018, the Senate passed bipartisan S.B. 1732, entitled the “Improving Access to Behavioral Health Information Technology Act.”  The bill, which is currently in the House of Representatives, aims to provide “incentive payments to behavioral health providers for the adoption and use of certified electronic health record technology…to improve the quality and coordination of care through the electronic documentation and exchange of health information.” o   In passing the bill, the Senate seems to be recognizing that comprehensive EHRs can help reduce costs to the entire healthcare system by maximizing productive physician-patient time while minimizing time unnecessarily spent re-conducting previously administered tests, asking previously answered patient history questions, etc. o   This incentive (if passed by the House) could benefit federally-defined psychiatric hospitals, community mental health centers, clinical psychologists, clinical social workers, and hospitals, treatment facilities, and mental health or substance use disorder providers that participate in Medicaid. o   You can read the text of the bill here: https://www.congress.gov/bill/115th-congress/senate-bill/1732/text. -On Friday, May 11, 2018, President Trump announced a blueprint for lowering drug prices, called “American Patients First.”  The blueprint identifies four key strategies for reform: (1) improved competition, (2) better negotiation, (3) incentives for lower list prices, and (4) lowering out-of-pocket costs.  The overall theme of these blueprint strategies appears to be transparency. o   To further the aim of incentivizing lower drug prices, the blueprint provides for...

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Costs Down; Quality Up

How can providers increase quality of care while reducing cost to patients?  The answer is through innovation, creativity, increased patient responsibility, partnership, and real-time flow of information.  Here are just a few ideas to consider in reaching this overarching goal.  While none of the ideas articulated below are novel or groundbreaking on their own, they are strategies that we have observed to be successful and that have benefited both patients and practices. Encourage Your Patients to Be Involved in Their Healthcare Decisions—Both Procedurally and Financially One of the keys to bringing costs down and letting the competitive consumer market assist in the process is having an informed clientele.  Often, patients do not see the costs of the services provided until after the numbers have gone through their insurance.  In the past, consumerism had little impact on the healthcare cost structure due to fear overriding frugality—no one wants to save a few hundred dollars on a particular test and then “die” as a result of that decision.  Find ways to encourage your patients to compare the true costs of their medical care by establishing the quality baseline.  For example, two identical CT Scanners sitting next to each other can have very different price points depending on their ownership. Once a patient understands the quality differential and that the less expensive one is the equal (or even superior) of the other,...

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The Health Law Blog is published by Dickinson Wright PLLC to inform the public of important developments within the firm and practice areas. The content is informational only and does not constitute legal or professional advice. We encourage you to consult a Dickinson Wright attorney if you have specific questions or concerns relating to any of the topics covered in this blog.

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