Members of the Health Policy News (HPN) team attended the NCSL Legislative Summit in Nashville from August 5-8, 2019, learning and sharing our work with legislators and staff from across the country. The trending topics this year that related to PCG’s work were: the impact of recent court cases at both the state and federal level; prescription drug pricing; and surprise balance billing.
NCSL Health Policy Update and Q&A
On Wednesday, August 7th, NCSL policy specialists and members of their HHS State-Federal Affairs team hosted a health policy update and Q&A for legislators and their staff. Generating the majority of discussion was the topic of prescription drug pricing and other ongoing federal efforts to assist consumers with rising healthcare costs—e.g., surprise medical bills and the recently finalized rule on Health Reimbursement Accounts (HRAs).
Prescription Drug Pricing
At the end of July, the current administration released the Safe Importation Action Plan, which gives states the flexibility to create and implement drug importation programs in an attempt to provide lower-cost medications to consumers. The executive order provides two pathways by which drug importation would occur: one allowing states to submit plans for a demonstration and provide evidence that certain cost and safety criteria would be met; and another opening up importation (to approved FDA drug manufacturers) of important medication sold in other countries into the US.
As we previously reported, some states (the first being Vermont) have enacted legislation to study the price impact of drug importation; the hurdle for many was whether or not the U.S. Department of Health and Human Services (HHS) would approve these importation programs. California and Florida also recently passed similar state drug importation studies and have program design plans underway.
HHS and the Department of Labor and Treasury also recently finalized HRA regulation that will permit employers to fund up to $1800 a year for employee use in paying premiums (including excepted benefit plan premiums) as well as allow employees to be reimbursed for certain qualified medical expenses. The new standards will go into effect in January 2020 and are applicable to a broader range of plan types than were previously eligible for HRAs.
Health Policy News Shares Insights into Mental Health Parity and Uniform Prior Authorization
In speaking with legislators, HPN subject matter experts wanted to provide information about tools related to mental health/substance abuse treatment services that we are currently developing with state clients—as well as insights into ways to potentially lower drug costs and improve efficiency of care delivery.
The two items we chose demonstrate were 1) a tool that reviews health products for mental health parity compliance, and 2) the process of moving to a uniform prior authorization process. Both of these topics recently gained support and increased focus in a number of states—and as legislators return to set their state’s health priorities for the upcoming legislative cycle, we know it is particularly helpful for them to see other states’ approaches to certain issues, as well as the steps these states took to achieve goals set out in particular legislation.
Whether you attended NCSL or not, we prepared the following fact sheets to provide insight into how certain states 1) are currently reviewing for mental health parity, or 2) went about moving to a uniform prior authorization form. If, after reviewing the fact sheets below, you have specific questions about your state or would like more information, please email us at email@example.com
Mental Health Parity
In demonstrating our work in mental health parity, we featured our efforts assisting states in ensuring compliance with regulations set forth to ensure equal access to, and coverage of, mental health and substance abuse treatment services. These requirements dictate that commercial health insurance plans and Medicaid plans monitor for parity between medical/surgical benefits (med/surg) and mental health/substance use disorder benefits (MH/SUD).
Most on/off exchange individual and small group plans, as well as some large group plans, are subject to the standards set forth in the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), and, in some instances, the expansion of protections included in the Affordable Care Act. In order to assist states with understanding their obligations to consumers, we put together a brief overview that also contains examples of tools we have used in states to help initiate a compliance review or automate existing review processes.
Uniform Prior Authorization
Prior authorization is a common tool for utilization management and controlling healthcare costs. While approaches to this process are similar across payers, each insurance carrier and public program has its own forms—with variations on questions asked, as well as how they are asked—and processes for submitting and processing those forms.
Healthcare providers report that these payer-specific forms and processes create administrative burden and delay needed treatments. As a result of those concerns, a growing number of states are beginning to implement uniform prior authorization forms, including California, Colorado, Massachusetts, Minnesota, New Hampshire, Oregon, and Texas. As states grapple with how best to reduce healthcare costs, moving to a uniform prior authorization process for some or all prescription-related approvals and/or medical/behavioral health services may reduce the administrative costs and burden associated with prior authorization—a small step towards larger health savings goals.