CONTENTS OF THIS ISSUE
Spring 2018 Issue |
|
APA District Branch Report
Psychiatric Society of Virginia District Branch Report to the Area V Council Meeting
American Psychiatric Association
March 24-25, 2018
John P. D. Shemo, MD, DLFAPA
PSV Representative to the
APA Assembly
A recent Milliman report was released which detailed a survey of how and to what extent the mental health parity law has been implemented in various states, this being the tenth anniversary of the passage of that law. Virginia ranked at the bottom in this survey.
The individual who has been the insurance commissioner in the State of Virginia for many years has, to put it gently, tended to not advocate strongly for the best interests of the citizens of the Commonwealth of Virginia with psychiatric and substance abuse disorders regarding issues of parity. In the context of consultation with the American Psychiatric Association legal team, I sent the attached letter to the Insurance Commissioner requesting a meeting to discuss the Milliman report and its implications. Prior letters to this commissioner, in my role as Chair of the Managed Care Liaison Committee of the Psychiatric Society of Virginia, had gone not only unanswered, but unacknowledged. On this occasion, I received a rapid response from a new insurance commissioner, just appointed by the new Virginia Governor who is a pediatric neurologist. The new Commissioner said that he would be “happy” to meet with me and would have the Virginia Commissioner of Health also join us.
On Friday, March 9, 2018, we had a meeting with the Virginia Commissioner of Insurance and the Commissioner of Health, and members of their staffs, including the Deputy Commissioner of Insurance. The PSV was represented by three physicians including Joe Mason, MD, the current President of the Psychiatric Society of Virginia, Steve Cunningham, MD, and myself. All three of us have credentials in both general and addiction psychiatry, relevant in the context of the “opioid crisis” in Virginia. We were very helpfully joined by Sam Muszynski, Colleen Coyle and Maureen Bailey of the APA legal team. They were impressively prepared. I introduced them to the Commissioners as legal professionals who have for years been involved with issues discussed in the Milliman report and having broad knowledge regarding what approaches to parity implication are and are not working across the country including the details of how and why various approaches are or are not successful.
We then had a very interactive and productive meeting of almost two hours. The commissioners were clearly very interested in what we presented and our concerns. They seemed to clearly perceive both the Virginia physicians and the APA staff as having commitment to the well being of patients with psychiatric and substance abuse disorders.
I could go into a lot more detail about specific issues discussed, such as limited patient access to psychiatric services related to insurance entities policies of using non-parity based reimbursement and dysfunctional appeal procedures as a way to discourage physicians from being in their provider networks. If patients can’t find “network” providers, denials of care are not even required to increase insurance company profits. We shared with the commissioners recent forms sent from two insurance entities required to file an appeal of a refused medication prior authorization request. One of the packets was 12 pages long and the other was 22 pages long.
In any case, the meeting was very encouraging and represented an excellent partnership between a District Branch and APA staff. It is important to note that the Insurance Commissioner did remind us that the system is complaint driven. If we see issues that negatively affect patient care or access to care, complaints need to be generated.
YOUR NEWSLETTER IS NOW AVAILABLE ON YOUR SMARTPHONE AND TABLET!
JOIN PSV TODAY!
REGISTER TODAY!
PSV 2018
FALL MEETING
September 28-29, 2018
Stonewall Jackson Hotel
Staunton, Virginia
APA Find a Psychiatrist
Are you accepting new patients?
Opt into APA’s “Find A Psychiatrist” database. To view the functionality or opt-in, CLICK HERE
FYI: A link for this option has been added to the PSV websiteSelect the “About” button and then “Find a Psychiatrist” from the drop down.