November 8, 2013

The Federal Final Interim Parity Rules for the Mental Health Parity and Addiction Equity Act (MHPAEA) will be made Final Rules today when they are published in the Federal Register at 11:15 am EST. This is a victory for the five years of work that CSWA and many other organizations have devoted to getting these rules in place, the key to enforcement of MHPAEA.

This is not the complete victory that CSWA had hoped for to the extent that enforcement has been delegated to state insurance commissioners. Variation in state laws and rules can make enforcement complicated and uneven. It will be interesting to see how the state insurance commissioners assume responsibility for self-insured, i.e., ERISA, plans which had previously been overseen by the Department of Labor.

CSWA will be tracking enforcement and pursue further legislation if the insurance commissioners are unwilling/unable to make the Final Parity Rules create the equal coverage that they are untended to provide.

The main positive impact of the parity laws and final rules are that the coverage of health plans' co-payments, deductibles and limits on mental health visits to licensed clinicians are not more restrictive or less generous for mental health benefits than for medical and surgical benefits for visits to licensed medical clinicians. However, the 'non-quantitative' limits, i.e., requiring pre-authorizations for psychotherapy, different levels of coverage in for in-network/out-of-network, and determining what 'parity' means in comparing frequency and length of psychotherapy to medical/surgical treatment remain to be defined.

Coincidentally, Medicare co-pays will reach the same level as medical co-pays - 20% - on 1/1/14 after 4 years of gradually decreasing mental health co-pays from 50%. The rules do not cover Medicare or Medicaid.

While the rules do not apply to Medicare and Medicaid specifically, though past CMS guidance to states has been that parity should be a goal in Medicaid plans.

While there is more work to do, this rule implementation is a good step forward.

October 15, 2013

Many LCSWs have been stymied by the fact that there is so little correlation between the PQRS measures and our diagnostic codes (DSM/ICD). The only measures that mention a diagnostic code are #106 and #107 for major depression. However, ALL diagnostic codes we use can be linked with whether people smoke, drink, use substances and several other behaviors that CMS is tracking. Use the QDCs that apply to them if you are sending in information for other diagnoses, which you can find on the CSWA website at www.clinicalsocialworkassociation.org under "Clinical Practice" and then "PQRS Options". Scroll down to find the PQRS Measures and QDCs for those Measures.

There is NO deadline today for LCSWs who send in their QDCs on the CMS-1500.  You can wait until February 28, 2014 to do so, though getting it out of the way sooner is a good idea. You should continue to send QDCs for Medicare patients on every claim.

I know what a difficult task this has been and hope that this information is useful in navigating these rough waters.

September 2013

Please visit the CSWA Position Papers page to view the Report on Online MSW Programs.