On June 12, 2018, the Committee on Energy and Commerce amended title XXI of the Social Security Act “to ensure access to mental health services for children under the Children’s Health Insurance Program” for all States. It specifically directed all states’ CHIP programs to cover mental health benefits including substance use disorder services for pregnant women and children.
The significance of the Mental Health Parity & Addiction Equity Act (MHPAEA) under CHIP cannot be understated, as parity litigation for children behavioral health services and substance abuse treatment has been an issue across clinical populations and treatment categories. Cases range from denial for outpatient Applied Behavioral Analysis (ABA) therapy for Autism to denial for residential level of care for substance addiction. For example, in the case of W.P. v. Anthem Ins. Cos (1:15-cv-00562) (S.D. Indiana) that involved claims that Anthem violated MHPAEA by limiting hours of ABA therapy that would be covered for children ages sever and older, Anthem agreed to pay $1.625 million for a common fund for the benefit of approximately 200 class members. In Munnelly v. Fordham University Faculty & Admin HMO Ins. Plan with Empire HealthChoice Assurance, the court found comparable definition of residential behavioral health treatment to medical rehabilitative treatment. The court also found that the plan violated MHPAEA under the Employee Retirement Income Security Act (ERISA) with the denial of residential behavioral treatment. The 2nd District Court has reserved the decision at this time for remedy for the MHPAEA violation.
Additionally, under the authorization of CHIP, mental health benefits including substance use disorder services for low income pregnant women are mandatory services. This addresses the treatment needs of pregnant women caught in the opioid epidemic and who need treatment access and support for a healthier pregnancy and delivery outcome. It seeks to turn the tide of the rising foster care cases and permanent placement needs of children impacted by the opioid epidemic.
SAE has worked extensively in the area of MHPAEA compliance monitoring, enforcement and implementation. SAE’s parity team understands the importance of policy to practice changes and ways to assist with needed enforcement activities.
If you would like to explore how we can help your agency in this arena, email firstname.lastname@example.org or call 212-684-4480 to connect with our team.