Health Plan Weekly

The Biden administration on Sept. 9 finalized a sweeping set of regulations that aims to ensure health plans are covering behavioral health treatment as comprehensively as they cover medical care. The move was met by rapid criticism from a coalition of trade groups representing health insurers and large employers, which argued the new regulations “will not address the inadequate supply of mental health providers.”  

But other groups, such as a mental health advocacy organization tied to the Kennedy family, welcomed the rules as a necessary step forward to ensure compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA). And one health policy expert tells AIS Health, a division of MMIT, that there are reasons to be skeptical of some criticisms lobbed at the new regulations by plan sponsors and insurers.

Health Care Service Corp. (HCSC), which owns Blue Cross Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas, recently rolled out an “alternative health plan” that combines what essentially is a tiered provider network, price transparency and streamlined medical billing.  

Industry experts who spoke to AIS Health, a division of MMIT, say HCSC’s new benefit design has a variety of intriguing elements that could prove attractive to employers. Indeed, UnitedHealthcare has in recent earnings calls been touting the rising popularity of a similar offering.  

Since Oregon placed a payment cap on hospitals for its state employee health plans, beneficiaries have seen a reduction in out-of-pocket spending and an increase in utilization, according to a recent JAMA Health Forum study. Roslyn Murray, Ph.D., the lead author, tells AIS Health that “there’s an appetite” from other states to implement similar price regulations, although they have faced pushback from providers. 

Changing coverage requirements for a slew of preventive services may be coming to health plans, as CMS eyes an update to Affordable Care Act provisions that may eventually extend to insurance markets beyond the federal and state marketplaces. 

On August 30, a new proposed rule, Enhancing Coverage of Preventive Services under the Affordable Care Act, was posted to the Office of Management and Budget’s (OMB) dashboard.