Welcome to the third edition of Greenberg Traurig’s Big Book of Behavioral Health Laws! The Ledger is intended for behavioral health and integrated health providers wishing to keep abreast of legal and regulatory developments in behavioral health law. Every quarter, we plan to publish a new edition of the Ledger to highlight new legal developments, including but not limited to audit risks, significant litigation developments, enforcement actions and changes in laws or regulations related to behavioral health such as health privacy, confidentiality. , and/or security issues, consent issues, data sharing allowances, and other state-of-the-art arrangements and issues faced by behavioral and integrated healthcare providers.
New York Expands Funding for SUD Mobile Treatment Services
On February 25, 2022, New York Governor Kathy Hochul announced that the state would make available up to $1,000,000 for Opioid Treatment Program (OTP) providers to establish mobile units of medication (MMU) to provide drugs such as methadone and buprenorphine, to treat substance use disorders (SUDs). MMUs will offer services including admission assessments, medication induction, medication administration and observation, toxicology testing, and other SUD-related medical services. Notably, the National Institutes of Health (among others) has been funding a clinical research trial in five major US cities since June 2021 to assess the effectiveness of using MMU in treating patients who inject opioids.
The goals of MMUs are to remove the transportation and geographic proximity barriers to treatment for SUD faced by many patients with SUD, and to increase the availability of medications for patients with a the use of opioids. The MMUs will complement existing mobile service offerings from providers certified by the New York State Office of Substance Abuse Services and Supports (OASAS). Ultimately, the MMU initiative aims to award one-time rewards of up to $200,000 to one OTP provider in each of New York’s five boroughs; however, OASAS may award more than one MMU per borough based on applicants. The development of MMU is made possible by the Drug Enforcement Authority’s (DEA) release of the MMU Final Rule and responds to the state’s need to increase the availability of OTP services. Previously, mobile clinics had to be registered separately, which prevented some clinicians from providing such services. Federal funding is provided to New York State through the State’s Federal Opioid Response Grant and is awarded through a request for applications administered by OASAS and its fiscal agent, the Research Foundation for Mental Hygiene. New York OTP vendors can click here to access the OASAS application solicitation. The application deadline is currently March 25, 2022.
States that lack accessible statewide OTPs would be well served to consider using state opioid response funding for MMUs, such as New York State, to address the opioid crisis. opioids and provide more patients with access to SUD treatment services. Medicaid can help support the treatment provided at MMUs because many people served by MMUs may be enrolled in Medicaid and states may charge for services provided.
Tri-Agency Report on Mental Health Parity Compliance and Enforcement
On January 25, 2022, the U.S. Departments of Labor, Health and Human Services, and Treasury released their 2022 Annual Report to Congress on the Mental Health Parity and Addictions Equity Act (MHPAEA). ), “Achieve parity, reduce stigma and increase awareness: increasing access to mental health and substance use disorder coverage(the report). The report is an assessment of current compliance and enforcement issues under the Mental Health Parity and Substance Abuse Equity Act of 2008 by Paul Wellstone and Pete Domenici, Federal law that requires equity in medical/surgical benefits and mental health/substance use disorders.
The purpose of the MHPAEA is to promote access to treatment for mental health and substance use disorders by prohibiting coverage limitations that may deny or significantly limit covered benefits. The MHPAEA requires the financial requirements (such as copayments) and treatment limitations (such as prior authorization requirements and other medical management tools) that apply to mental health and substance abuse benefits cannot be more restrictive than the prevailing financial requirements and treatment limitations that apply to virtually all medical and surgical benefits. The Department of Labor’s Employee Benefits Security Administration (EBSA) and the Centers for Medicare and Medicaid Services (CMS) have primary enforcement authority for the MHPAEA, with enforcement jurisdiction divided by type scheme or issuer.
To better facilitate enforcement, in the Consolidated Appropriations Act of 2021 (CAA), Congress amended the MHPAEA to require plans and issuers to perform benchmarking of their non-quantitative treatment limits. The report indicates that many plans and issuers were not prepared to perform and document the required benchmarking analyses, and that most of the analyzes reviewed contained insufficient information.
According to the report, health plans and health insurance issuers are also failing to meet joint coverage requirements, a potentially concerning trend given the rise in mental health and addictions issues related to the COVID pandemic. -19 in progress. Examples of non-compliance cited in the report include several plans that excluded applied behavior analysis to treat autism spectrum disorders, a broad health plan that excluded methadone and naltrexone for the treatment of substance use, and two major plans that covered nutritional counseling for medical purposes. /surgical conditions such as diabetes, but did not cover comparable advice for mental health issues including eating disorders.
In response to the report’s findings, EBSA and CMS intend to strengthen enforcement of the MHPAEA by continuing to request and review disclosure requirements, investigate plans and issuers, publish plans corrective actions, to recruit and train additional staff and to provide technical assistance if necessary.