RAND has a report on implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. Contracted by the HHS Assistant Secretary for Planning and Evaluation, RAND interviewed several representatives of managed behavioral health organizations (MBHOs)
A few examples were given of services that are not covered because they are not considered medically necessary: (1) “wilderness” programs for youth -- because of no evidence of effectiveness and the lack of clinically credentialed staff; and (2) Applied Behavioral Analysis (ABA) for autism, because it is considered educational rather than medical. [emphasis added] In addition, industry leaders mentioned limited coverage for psychological testing, because while it is clinically appropriate to rule out certain diagnoses, it is also a service that is subject to abuse. Some industry representatives suggested that these services may serve useful social functions but are not evidence-based behavioral health treatments....These organizations reported using standard credentialing checks to decide which providers to include in their networks. Some leaders mentioned excluding certain subspecialties (for example, specialty providers of ABA for autism) ,[emphasis added] and reported doing ongoing evaluations of network providers. One industry leader noted that a problem for all organizations is a shortage of psychiatrists in many geographic regions (especially in rural and frontier areas), and that they work hard to credential and include as many psychiatrists as apply. Another noted that exclusion of individual providers was done only on the basis of “egregious” quality issues.
Insurance Commissioner Dave Jones today announced that he has reached another favorable agreement with an insurer, UnitedHealthcare Insurance Company, to require immediate coverage of behavioral therapy for autism as a medical benefit. This new agreement is the latest step in an industry wide compliance initiative by Commissioner Jones. It follows three settlements reached earlier this year with Blue Shield, Health Net and Cigna to provide behavioral health treatments, including Applied Behavior Analysis (ABA), a well-recognized and effective treatment for autism. In addition, Commissioner Jones reconfirmed that yet another major health insurer, Anthem Blue Cross of California, has been providing the coverage pursuant to Department of Insurance (CDI) direction since November 2009.
