08/24/2015

Court rules third-party claims administrators may be sued over mental health parity law

From the APA: "We are delighted to report that, yesterday (Aug. 20, 2015), the U.S. Court of Appeals for the Second Circuit REVERSED in part the district court’s dismissal of a key mental health parity case brought by the New York State Psychiatric Association (NYSPA) and others.  The decision is attached.  Congratulations to NYSPA on this decision, which improves Mental Health Parity Act enforcement.   Accomplishments of this decision include:

• Recognition that NYSPA could represent its members and their patients in pressing a claim under the Mental Health Parity Act through Associational Standing.  This issue may sound familiar to you, because APA, and separately the AMA, filed Amicus Briefs in this case addressing this point.
• Recognition that United could be sued even when it acted not as the insurer, but as the administrator of a self-insured plan.  United argued that because it was not the insurer, the plaintiffs had to sue their employers who provided the health plan.  NYSPA and the US Department of Labor argued otherwise.  The Court concluded that carriers who violate MHPAEA and exercise significant discretion in the administration of the plan’s benefits were appropriate defendants.

This is a victory for psychiatry.  We congratulate our New York colleagues for pressing the case.

http://law.justia.com/cases/federal/appellate-courts/ca2/14-20/14-20-2015-08-20.html

Please note that our Anthem case will be argued on Sept. 21 in the same court.  This case takes on the issue of whether disparities in rates paid to psychiatrists which results in reduced access to care violate the parity act and whether APA can bring this case on behalf of its members and patients.  We are analyzing the NYSPA decision to understand its impact on that case.

More to come as we all work together to strengthen enforcement of mental health parity.

Sincerely,

Renée Binder, M.D.                        Saul M. Levin, M.D., M.P.A.
APA President                               CEO & Medical Director

More news . . .

Reuters (8/21, Pierson) reports that the 2nd US Circuit Court of Appeals has ruled unanimously that the New York State Psychiatric Association has standing to sue UnitedHealth Group for treating mental health claims differently than other health claims and claims administrators may be liable for coverage decisions under the Employee Retirement Income Security Act (ERISA).

Modern Healthcare (8/21, Schencker, Subscription Publication) reported that in an Aug. 20 ruling, “a panel of judges for the 2nd US Court of Appeals decided...that UnitedHealth Group, as a third-party administrator for an employee health plan, is not exempt from ERISA, which regulates traditional pensions and other employer-provided benefits.” The panel also ruled that “under ERISA, the administrator must follow the mental health parity law.” The ruling may “lead to more patients and [healthcare professionals] challenging plan administrators who try to limit access to mental health services, some say.”