Insurers slam mental health parity plan

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Oct 18, 2023 View in browser   By Ben Leonard and Chelsea Cirruzzo Presented by With Robert King, Megan R. Wilson and Erin Schumaker  Driving The Day President Joe Biden wants to expand access to mental health care, but insurers argue that the proposed rules could have unintended consequences. | MandelNgan/AFP via Getty Images PARITY REG SKEPTICISM — The Biden administration has proposed expanding requirements for insurers to cover mental health and substance use treatment as they do for other care — and insurers aren’t happy. The administration received more than 9,000 responses during the comment period, which closed Tuesday. The regulations would expand requirements under a 2008 law and mandate that insurers analyze their coverage to ensure equivalent access to mental health care based on outcomes. The administration has accused insurers of failing to comply with parity regulations, pointing to a 2022 report to Congress from HHS and other agencies that found not one of the 156 insurance plans and issuers studied followed rules requiring them to measure their compliance. Organizations like the American Hospital Association and the American Medical Association, plus mental health advocacy groups like the Kennedy Forum, have been enthusiastic about the proposal. Insurers want changes.  AHIP, the lobbying group for insurers, argued workforce shortages are the main driver of barriers to care. The Blue Cross Blue Shield Association said that all deserve affordable access to care, and their plans work to ensure access. However, BCBSA argued that the regulations could have “unintended consequences,” including impeding access and imperiling patient safety by potentially forcing plans to accept lower-quality providers. It called for a more “comprehensive approach” that would address workforce shortages, licensing and other issues. “Parity is an important part of that puzzle, but we can’t address the mental health crisis by only addressing payment and parity,” David Merritt, SVP of policy and advocacy at BCBSA, told Pulse. The Alliance of Community Health Plans and the ERISA Industry Committee, or ERIC, similarly agreed with the administration’s aims to ensure access but panned the proposal. “The proposed regulations are so unworkable, it is unclear how compliance could ever be achieved while continuing to offer these important benefits,” said James Gelfand, president of ERIC, which represents large employers’ benefit interests. The groups, to varying degrees, took issue with proposed requirements for plans to analyze the impact of practices intended to limit unnecessary care. Gelfand argued the administration is attempting to dissuade most of those limitations from being implemented. BCBSA said the administration should drop a requirement that plans examine whether such limitations are more restrictive than for “substantially all” medical and surgical benefits. ACHP wants the administration to offer more clarity and said it has “significant concerns” about the provision. View from Congress: Rep. Virginia Foxx (R-N.C.), chair of the House Education and the Workforce Committee, said the administration is going beyond its authority. “The … proposed rules will serve only to weaken parity compliance by giving prominence to bureaucratic reporting, paperwork, and audits,” Foxx wrote. The panel’s top Democrat, Bobby Scott of Virginia, and health subcommittee ranking member Mark DeSaulnier (D-Calif.) backed the proposal in a letter first shared with Pulse but said the administration should go further in limiting exceptions. WELCOME TO WEDNESDAY PULSE. In more mental health news, Sens. Michael Bennet (D-Colo.) and Thom Tillis (R-N.C.) and Finance Chair Ron Wyden (D-Ore.) released legislation today aimed at addressing so-called ghost networks that appear to have many providers on paper but not as many in practice. Reach us at bleonard@politico.com or ccirruzzo@politico.com. Follow along @_BenLeonard_ and @ChelseaCirruzzo. TODAY ON OUR PULSE CHECK PODCAST, host Lauren Gardner talks with POLITICO health care reporter Kelly Hooper, who reveals why the new Biden administration's price transparency rules are hindering — and not helping as intended — employers' ability to shop around for better deals from insurers. Listen to today’s Pulse Check podcast   A message from PhRMA: PBMs are siphoning money away from you.  They decide what you pay and what medicines you can get. PBMs steer you toward pharmacies they own that make them more money.  And, they’re creating new fees that pad their profits, but don’t benefit patients. Learn more.   In Congress The Senate will hold a confirmation hearing today for a new NIH director. | J. Scott Applewhite/AP NIH IN THE HOT SEAT — President Joe Biden’s pick to run the National Institutes of Health, Dr. Monica Bertagnolli, gets her confirmation hearing before the Senate HELP Committee today after five months’ delay, Erin reports. It’s been more than a decade since an NIH nominee was questioned by senators. The most recent director, Dr. Francis Collins, was unanimously confirmed without a hearing in 2009. But while recent directors smoothly sailed through the process, Bertagnolli’s rocky road to a hearing suggests a changed political environment.  Her upcoming experience before the Health, Education, Labor and Pensions Committee could signal an important moment for the $45 billion agency — either a return to its long history of bipartisan support or more evidence that the pandemic turned it into a political football. The agency hasn’t had a permanent director since Collins left in December 2021. What to expect: Bertagnolli, who directs the National Cancer Institute, is likely to field questions on how she'll address drug pricing from Chair Bernie Sanders (I-Vt.), while ranking member Bill Cassidy (R-La.) wants to know how she’ll improve agency transparency and address how public trust eroded in the NIH after Covid arrived.   Senators will undoubtedly ask about Bertagnolli’s plans for the agency, said Erik Fatemi, a principal at lobbying firm Cornerstone Government Affairs and former Democratic staffer on the Senate Appropriations subcommittee with authority over NIH funding. “It’s been a long time since NIH has had a permanent director,” he said, adding, “They’re going to want to know, ‘Hey, what is your vision for the preeminent biomedical agency in the world?’” What’s next: The HELP Committee will vote on Bertagnolli's nomination following the hearing. That vote hasn’t been scheduled, according to Sanders’ office, but could come sometime next week. BERNIE DOUBLES DOWN — Sanders is plowing forward with a planned HELP Committee field hearing this month despite concerns from Cassidy that it could violate Senate rules. Sanders has planned a hearing on Oct. 27 on hospital understaffing in New Jersey, where 1,700 nurses at nonprofit Robert Wood Johnson University Hospital have been on strike. Cassidy took issue with Sanders using committee resources to support unions during a labor dispute, which Cassidy wrote in a letter Friday potentially violates Senate rules. Sanders released a statement Tuesday doubling down on the hearing without directly addressing Cassidy’s concerns, saying the nation faces a nursing crisis. “Senator Cassidy may be surprised, but some of us think the function of the committee is not just to represent corporate interests,” Sanders told Pulse. Cassidy responded on X: “The committee is there to fact find and understand without bias, not to act on and promote preconceived notions. To suggest something different is to abuse what the committee process is about.” Zooming out: It’s another escalation of the Sanders-Cassidy tensions that have pervaded the HELP Committee this year. Most recently, Sanders teamed up with Sen. Roger Marshall (R-Kan.) to advance a primary care bill over Cassidy’s objections.   GO INSIDE THE MILKEN INSTITUTE FUTURE OF HEALTH SUMMIT: POLITICO is proud to partner with the Milken Institute to feature a special edition of our Future Pulse newsletter at the 2023 Milken Institute Future of Health Summit from November 6-8. The newsletter takes readers inside one of the most influential gatherings of global health industry leaders and innovators solving the biggest public health issues to ensure a healthier, more resilient future for all. SUBSCRIBE TODAY TO RECEIVE EXCLUSIVE COVERAGE.     Around the Agencies CMS NIXES MA ADS — CMS struck down more than 300 ads touting Medicare Advantage plans because regulators found the spots to be misleading, Robert reports. The agency told POLITICO that from May 1 through Sept. 30, it rejected more than 1,700 ads. Of those ads, regulators rejected more than 300. The numbers provided to POLITICO come as the Senate Finance Committee will hold a hearing today on deceptive Medicare Advantage marketing amid open enrollment. CMS added that it reviewed 250 ads from third-party marketing organizations, and agency reviewers rejected 192. The Biden administration has moved to clamp down on deceptive marketing after a surge of complaints from older Americans that ads can be misleading over the types of benefits plans offer. “CMS is really trying to crack down on this,” said Meredith Freed, senior policy analyst with the think tank KFF’s Medicare policy program.   A message from PhRMA:   Mental Health Sen. Alex Padilla, joined by Sens. Tina Smith and Thom Tillis, announces the formation of the Mental Health Caucus. | Courtesy Alex Padilla NEW MENTAL HEALTH CAUCUS — Sens. Alex Padilla (D-Calif.), Tillis, Tina Smith (D-Minn.) and Joni Ernst (R-Iowa) announced Tuesday that they were launching the Mental Health Caucus. The new 10-member caucus, evenly split between parties, will aim to address health care workforce issues, raise awareness about the 988 crisis hotline and ensure the Bipartisan Safer Communities Act is implemented “thoughtfully, strategically and effectively,” Padilla said. Padilla told Pulse there needs to be a “master plan” akin to efforts post-Affordable Care Act for the mental health workforce. He also added that mental health and substance use issues often go hand in hand, so the caucus would look to address them as well. In a press conference, Smith nodded to telemental health as an important tool to expand access to care and noted mental health parity as an ongoing issue. The other members of the caucus are Sens. Cory Booker (D-N.J.), Shelley Moore Capito (R-W.Va.), Susan Collins (R-Maine), John Fetterman (D-Pa.), Amy Klobuchar (D-Minn.) and Lisa Murkowski (R-Alaska). Padilla said he expects the caucus to get “much bigger” with time.   A NEW POLITICO PODCAST: POLITICO Tech is an authoritative insider briefing on the politics and policy of technology. From crypto and the metaverse to cybersecurity and AI, we explore the who, what and how of policy shaping future industries. We’re kicking off with a series exploring darknet marketplaces, the virtual platforms that enable actors from all corners of the online world to traffic illicit goods. As malware and cybercrime attacks become increasingly frequent, regulators and law enforcement agencies work different angles to shut these platforms down, but new, often more unassailable marketplaces pop up. SUBSCRIBE AND START LISTENING TODAY.     Names in the News The Public Innovation Project, which will tackle patent policy and be run by InSight Public Affairs, launched Tuesday. Matthew Lane will chair the group's board. WHAT WE'RE READING The New York Times reports that scientists think low serotonin might be behind long Covid in some people. Healthcare Dive reports on Amazon’s One Medical rebranding a chain of senior clinics to “One Medical Seniors.”   A message from PhRMA: Health insurers and PBMs can refuse to share savings that should go to you. Now they’ve got another trick. A new report shows  PBMs found new ways to profit off your prescriptions. They’ve doubled the amount of fees they charge on medicines in the commercial market. They tie these fees to the price of medicines. And experts warn this can lead PBMs to cover medicines with higher prices instead of lower-cost options.      Follow us on Twitter Dan Goldberg @dancgoldberg Chelsea Cirruzzo @chelseacirruzzo Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Kelly Hooper @kelhoops Robert King @rking_19 Ben Leonard @_BenLeonard_ David Lim @davidalim Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Evan Peng @thepngfile Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Megan R. Wilson @misswilson   Follow us

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