Does S. 558 allow health plans to manage benefits and utilization of treatment services?
Yes. As noted above, parity has never been about achieving special status for mental health benefits in group health plans, but rather coverage that is equal to all other medical conditions. As a result, any effort to use parity legislation as an opportunity to curb or challenge the ability of plans to engage in medical management of benefits through utilization review, exclusion of services deemed not medically necessary, etc. could not be included. In other words, a threshold decision was made that if Congress is to consider such protections as part of “Patient Bill of Rights” legislation, it will do so by focusing on all health conditions (both medical-surgical and mental health). Parity is not an opportunity to address such issues solely for mental health. As a result the bill contains “clarifications” stating that nothing in the bill bars plans from managing mental health benefits through use of medical necessity, utilization review, prior authorization of high cost services, etc.
