Category: SOS Blog

Managed Care Organizations Oppose Parity

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An organization called the Coalition for Parity, Inc. comprised of managed behavioral health organizations (MBHOs) has filed suit to halt the implementation of the Paul Wellstone and Pete Dominici Mental Health Parity and Addiction Equity Act. This group has as some of its members Value Options, Magellan Health Services Inc., and Beacon Health Strategies Inc.

As reported by Open Minds and American Psychological Association Practice Organization, the lawsuit challenges the rulemaking process and has requested a temporary restraining order to stop the rulemaking process from moving forward. They argue that the Departments of Health and Human Services, Labor and Treasury overstepped their rulemaking authority in how they interpreted the statutory language and violated federal rulemaking procedure in publishing the rule as they did. While the judge denied the temporary restraining order because the law will not be enforced until July 1, 2010, the court will hear the case as presented by the parties to the action.

On May 9, 2010, the NY Times reported that insurance companies and employer groups are also objecting to the rules.

In a suit over the rules, Magellan and other companies said the concept of nonquantitative limits was “boundless and ill defined” and would reach virtually every policy and procedure used to manage mental health benefits.

As most mental health providers can readily attest, the procedures used by insurers and managed care organizations to limit costs and usage of behavioral health services have themselves been “boundless and ill defined”; after all, a treatment plan certainly could not be a valid treatment plan if it is printed on the wrong form. The MBHOs have been innovative in their development of “every policy and procedure used to manage mental health benefits.” Unfortunately, most of that management has consisted of denying or limiting the amount of service provided and placing onerous requirements on providers.

The NYTimes article states that:

One premise of the law is that mental illnesses often have a biological basis and can be treated as effectively as many physical ailments. But insurers say it is impossible to use the same techniques in managing the treatment of colon cancer and schizophrenia, or heart failure and major depression.

What do you think? Is it reasonable to assume that mental illness and addiction can be managed using the same techniques as are used to manage the treatment of cancer or heart disease?

Please share your comments below.

Patient Consent for Exchange of Information

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The HITECH section of the American Recovery and Reinvestment Act (ARRA) added privacy and security requirements that providers of health care services must follow in handling the Protected Health Information (PHI) of those they treat over and above those provided for in HIPAA. HIPAA allowed PHI to be exchanged for treatment and operations without patient consent as along as patients were so notified in the organization’s Statement of Privacy Practices.

HITECH provides for stronger controls. It requires that the provider be able to inform the patient (upon the patient’s request for the information) about all the times that PHI has been released by the organization (disclosures), to whom it was released, and the purpose of the release. This includes release of information for operations and billing. If you send claims to an insurance carrier via a clearinghouse, you would need to be able to document every time a claim was sent and that it went to both the clearinghouse and the insurance company. If you send it to the payer directly on their web site, you would still need to be able to document every time you did that.

HHS has been gathering comments from provider organizations about the burden this will place upon them. How the rules are ultimately written remains to be seen.

At the same time, the HealthIT Policy Committee has been working on a framework for privacy and security of PHI as we move toward EMRs and the electronic exchange of identifiable personal information. An attempt is being made to come up with methods and understandings that will allow a national standard and method of exchanging PHI in spite of different laws and requirements in each of the 50 states. A Privacy and Security white paper series explores these issues.

Part of the current concern is the point in an exchange at which a specific consent should be required from a patient for release of their information. It is believed that patients feel fairly secure when provider #1 releases information to provider #2 whether the provider is a lab or another physician. Trying to determine the point at which comfort in an exchange is lost and the requirement of consent is triggered is part of the challenge. For example, if provider #1 has consent to send information to provider #2 but the only method of doing so is through a third party (like a clearinghouse or directory), does additional consent need to be obtained for that transaction? What kind of situation must exist to trigger a patient’s right to “opt out” of the electronic transaction.

These are important issues that pertain to information electronically exchanged for billing and operations as well as for treatment. Avoiding the use of an EMR will not shield you from addressing these issues if you send claims electronically. . . even at a payer’s web site. 

What do you think about protecting the PHI of the consumer of services?  What are you doing to assure that you meet the requirements of the law? Please share your thoughts and comments below.

Bits of News for Behavioral Health Providers

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I have recently noticed several pieces of news that I thought would be of interest to providers of behavioral health services and others.

1. The National Council Public Policy Update of April 8, 2010 pointed out an important change in timely filing requirements for Medicare claims:

Requirements of the Patient Protection and Affordable Care Act makes (sic) several changes to the Medicare timely filing requirements. Under the new law, all claims from before Jan. 1, 2010 must be filed by Dec. 31, 2010. Beginning on Jan. 1, 2010, all claims must be filed within one year after the date of service in order to be considered timely.

Sec. 6404 of the law details the requirements. This is a change from the former allowance of 3 calendar years to file a claim. Be clear about this: you now have 1 calendar year after the date of service to file a timely claim for payment for those services.  Now might be a good time to use your billing software to learn which old Medicare claims have not been paid (the claims may have been lost) and if there are any Medicare services that have not been billed. If these are not already three years old, you have only until the end of 2010 to file them, and with services that are new in 2010, you have one calendar year to file a claim for the services.

2. Seth recently posted a message on our User Group about the potential privacy and security problems that can be caused by data left on newer copiers and multifunction machines. NJAMHAA Newswire of May 3, 2010 also commented on the possibility of HIPAA violations that can result from careless use of these machines. Seth’s comments follow:

Now that you finally got all your computer hard drives encrypted and you are feeling pretty smug, here comes another headache — thousands of images containing PHI stored on a hard drive hidden inside other office machines. Take a peek at this investigative report by CBS news:

http://www.youtube.com/watch?v=6pIFUOav2xE

This is a pretty big vulnerability. If you have one of these higher end digital copiers, printers, or multifunction machines and it is stolen — or you neglect to remove or wipe the hard drive before selling or trading it in, you have a reportable security breach. Nobody would be likely to have a list of the patient documents that had been copied over the years, so you
would have to assume that EVERYONE’s protected information was at risk. That means reporting to the Feds, taking out the newspaper ad announcing your negligence, and the rest of the breach notification nightmare!

Apparently all major manufacturers offer security add-ons of some sort. Now would be a good time to inventory your document devices to determine if they contain hard drives and whether you can retrofit appropriate security add-ons to avoid a potentially disastrous situation in the future.

3. The National Council on April 23 published a review of Parity Act implementation that will allow you to determine whether your insurer or the payer with which you are dealing is in compliance with the Parity Act. Is your insurer in compliance with the Parity Act? will help you ask the right questions and provides resources to help you answer the question.

4. On April 22, FierceEMR and other sources reported that hospital-based doctors are now eligible for ARRA incentive payments for meaningful use of certified EHR technology, and that a bill has been introduced by Rep. Patrick Kennedy (D-RI) and Rep. Tim Murphy (R-PA) seeking to include mental health professionals, Community Behavioral Health Organizations (CBHOs), psychiatric hospitals and chemical dependency programs in the ARRA incentives. Time will tell what will fly.

5. And finally, the Mercom Capital HIT Report of May 3 indicated that HHS is seeking comment on the anticipated impact the stricter disclosure reporting requirements included in the HITECH Act will have on providers.

To help guide the Health and Human Services Department in tightening rules for health information privacy, HHS has asked providers, payers and consumers to comment on the benefits and burdens of accounting for the disclosure of protected health information, even if the data is intended for treatment and billing purposes. The HITECH Act called for HHS to strengthen the privacy rule of the Health Insurance Portability and Accountability Act (HIPAA). With the changes, providers, plans and their business partners will have to account for disclosures of patient information contained in an electronic health record, even if the data is for healthcare provision and payment. 

HHS’ Office of Civil Rights (OCR), which oversees health information privacy, published a request for comments in the May 3 Federal Register 
“to inform our regulations under the HITECH Act,” according to the announcement. Under HIPAA, providers and plans currently do not have to report releases of protected data when the disclosures are related to patient treatment, payment and healthcare operations. HHS said in the notice that it will remove the exemption for those disclosures when it involves an electronic health record (EHR).

Needless to say, there is a great deal going on in the world of behavioral health care and health care in general. Please feel free to share news items you discover that might be useful to other readers.

Don’t forget, your comments are always welcome. Please share them below.

Resources for Behavioral Health Providers

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I read lots of articles online…or I download the articles and read them in .pdf format. Seth found a free tool that is going to make this whole reading and organizing process easier for me. It is called PDF-XChange Viewer and it can be downloaded for FREE! If you like to highlight and make notes as you go, this is a great tool.

That resource is really just a lead-in. In case you have not already collected some of the following sources from my references to them in other articles, I am going to put them all in one place. These are newsletters and web sites that are chock full of information that can help you stay informed about changes in the health care and regulatory world.

  1. My favorite by far is The National Council (NCCBH). This organization produces regular newsletters on varied topics, but I find their Public Policy Update to be an invaluable source of information on laws and regulations, policy trends and how you can address them. I have also greatly enjoyed their Webinars. Ordinarily, I would have already registered for the program coming up on Friday, May 14, What is an Accountable Care Organization and Why Should I Care? Since I will be out of town, I won’t be able to attend when it is broadcast; instead, I will watch it at a later date from the web site. The best part is that these programs are free and you do not need to be a member to participate in them. They are provided as a service to the behavioral health community.
  2. Every Monday, I receive a free multi-paged newsletter from the Mercom Capital Group, LLC of Austin, TX and Bangalore, India. This newsletter pulls capsules of information from a large variety of sources providing a quick overview of events in the domain of health care technology and health care policy. If you are interested in trying it out, send your email address to Raj at HIT@mercomcapital.com. 
  3. Open Minds is a longstanding and thorough source of industry information and strategy specifically for behavioral health provider organizations. While there are an abundance of workshops, webinars and premium programs, the Open Minds Circle is a free-for-the-registering newsletter from founder Monica Oss and others at Open Minds.
  4. Behavioral Healthcare and Healthcare Informatics (products of the Vendome Group), the U.S. Department of Health and Human Services, and the Office of the National Coordinator for Health Information Technology all have mass quantities of information to offer you, all available online.

The amazing thing to me is that this is just a small list. If you were to add in blogs, the amount of free, high-quality information available to you on the web is overwhelming. Choose wisely…and use that free .pdf markup tool to make it easier!

Please share with the rest of our readers sources of behavioral health industry information upon which you rely. Just enter your comments in the box below.

License to……

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Every two years around this time I am busy completing my Continuing Education Units (CEUs) so I can renew my license as a psychologist. I have done this every biennium since 1980, even though I retired from practice 17 years ago. In Florida, the license is both a practice and title act…to represent myself to the public as a psychologist, I need to be licensed. This was the first year I have even vaguely questioned why I continue to do so.

The decision to renew has usually been an easy one for me to make even though I do not practice and have no plan to return to work as a psychologist. I have a strong identification as a psychologist. I knew since early high school that I wanted a Ph.D. in clinical psychology; I always wanted to practice independently.

Even when we decided to relocate to central Florida and I took the opportunity to close my practice and work with SOS full time, I never considered dropping my license. After all, we have always told you that we provide software by psychologists for psychologists (and all other behavioral health providers). And anyway, who knows what time and politics will bring!

Usually my reading is a way to meet my CEU requirements and keep up with the clinical side of psychology. This year I was surprised; two of the articles I read this weekend were actually quite interesting to me; they were articles on personal or life coaching and Positive Psychology. Both of these areas have roots in the personal growth and Humanistic Psychology movements of the 1970’s, but are 21st century, mainstream ways of implementing growth-oriented interventions.

As the healthcare arena changes over the course of the next few years, it is highly likely that some organizations will seek to provide pure healthcare services. Others will choose to diversify their services in a variety of ways…and even to provide their services in unique fashion. Open Minds recently discussed both telehealth delivery of services and the use of virtual reality interventions to treat certain problems.

What new kinds of therapy has your organization considered? Do you continue to provide the same services you have always performed, or are you on the lookout for ways to diversify? What criteria do you use to decide if a particular service or technique should be added to your bag of tricks?

Please share your comments. We would love to know how you expand the services your organization provides. Just enter your comment in the box below. If you do not see a box, click on the title of the article and scroll down to the comment box. Thanks for reading!