Milliman Report: Analyzing Disparities in Network Use and Provider Reimbursement Rates

Friday, December 1, 2017 General News
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The following is a statement from Mark Covall, President and CEO, NAPHS:

WASHINGTON, Nov. 30, 2017 /PRNewswire-USNewswire/ -- The National Association of Psychiatric Health Systems (NAPHS) commends

the researchers at Milliman, Inc. for their comprehensive analysis on the disparities between addiction and mental health and physical health related to in-network use and provider reimbursement rates.

Although regulations for the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) initially became effective in 2010, we still see too many examples in which parity doesn't exist. In this new report, researchers found that in 2015 on average 31.6 percent of outpatient facility behavioral healthcare was accessed out of network, while only 5.5 percent of outpatient facility medical/surgical care was accessed out of network. At the same time, 18.7 percent of behavioral health office visits were accessed out of network, while 3.7 percent of primary medical/surgical visits were accessed out of network.

Meanwhile, the researchers found that medical primary care and specialty providers were paid on average about 20 percent higher rates than behavioral health providers for the same office visits billed under identical or similar codes. And in some states, the payment rate disparities were two to three times greater.

The research shows that if there are in-network access challenges, patients who choose to visit out-of-network providers usually pay more from their own pockets to pay for services they need. Consequently, as the study rightly notes: "Some patients may want to avoid the higher costs and delay seeking needed services from behavioral healthcare providers, which can lead to less effective care."

We see these as potential parity violations. Based on these findings, we recommend insurers review their parity compliance programs to ensure they are following the law and implementing its regulations. And we urge regulators to identify and eliminate any instances of discrimination against individuals and families who seek services for mental health and substance use disorders.

Click here to read the report:

The National Association of Psychiatric Health Systems advocates for behavioral health and represents provider systems that are committed to the delivery of responsive, accountable, and clinically effective prevention, treatment, and care for children, adolescents, adults, and older adults with mental and substance use disorders. Its members are behavioral healthcare provider organizations that own or manage more than 800 specialty psychiatric hospitals, general hospital psychiatric and addiction treatment units and behavioral healthcare divisions, residential treatment facilities, youth services organizations, and extensive outpatient networks. The association was founded in 1933.

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SOURCE National Association of Psychiatric Health Systems (NAPHS)


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