Magazine article Behavioral Healthcare Executive

Defining, Defending Treatment Parity - One Example at a Time: When Parity and Treatment Advocates Sought an Issue Reporting Mechanism, NAATP Delivered

Magazine article Behavioral Healthcare Executive

Defining, Defending Treatment Parity - One Example at a Time: When Parity and Treatment Advocates Sought an Issue Reporting Mechanism, NAATP Delivered

Article excerpt

One of the toughest challenges facing treatment advocates in the years between the passage of the MHPAEA in 2008 (and release ofits interim final rules in February 2010) and the release of final federal rules in November 2013 was in documenting and presenting evidence to lawmakers that would convince them of the need for strong and detailed final regulations.

But advocates, including treatment centers, faced a dilemma: while parity's rulemakers sought documentation of parity-related concerns and possible violations, treatment organizations hesitated to provide it. They learned that reporting possible violations would require them to publicly identify themselves, risking a confrontation with an insurance payer and, as Cumberland Heights CEO Jim Moore puts it, "biting the hand that feeds you." The reporting rules offered no form of "whistleblower" protection to treatment centers, who feared that reports might incur an insurer's wrath later on.

"We heard that the discussion in Washington D.C. was that treatment centers had no issues with the interim rule. Lawmakers thought it was working fine," recalls Nate Kasper, business operations manager at Valley Hope (Norton, Kan.). But NAATP leaders--and many member organizations--knew otherwise, so NAATP set out to create a means to make the needed data available while protecting patient and provider identities.

What resulted, after some months of effort, was a web-based tool, the NAATP Parity Reporting Survey. The brainchild of Bill Leech, healthcare reform analyst at Cumberland Heights (Nashville, Tenn.) and Kasper, the Survey offers NAATP members (and non-members, too) a means of creating structured reports about potential parity violations, complete with supporting documents, in a nationwide database. The database is "blind," meaning that it contains no patient- or facility-identifying information.

Facility identifying information, the key to the database, is held by NAATP. By contacting NAATP and requesting access, any facility or organization can obtain a unique identification code, use it to log into the survey, and document parity concerns or possible violations. All reports from a particular facility are labeled with only with its unique identification code, then labeled sequentially by that facility upon submission.

The code/key structure enables both member and now, non-member treatment facilities to enter detailed reports without any patient or facility identifying information. Periodically, the Survey tool then automatically collates the reports according to user-specified criteria and can produce summary reports on a national or (coming soon) state-by-state basis.

To help state associations and national advocacy groups such as the Parity Implementation Coalition (PIC) with parity enforcement activities, Kasper says that NAATP is making Survey reports available to these groups as well, provided that group officials complete a Qualified Services Organization (QSO) agreement, a precaution against even inadvertent disclosures in the blind database. (Under CFR 42, Part 2, QS0s bar the redisclosure of patient-identifying information by business associates of addiction treatment organizations.)

The beauty of the blind database is that, should regulators request additional details about a reported parity issue, or seek information direct from a treating professional, patient, or patient family, all they have to do is contact NAATP. …

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