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March 6, 2017

Network adequacy echoes parity laws

Behavioral Healthcare Executive

Harry NelsonHarry Nelson was quoted in the article, “Network adequacy echoes parity laws,” published in Behavioral Healthcare Executive on March 6, 2017. The following is excerpted from the article:

Under the Health Parity and Addiction Equity Act of 2008 (MHPAEA), health insurance providers are prohibited from imposing less favorable benefit limitations on mental health and substance use disorders than they impose on medical or surgical benefits.

One aspect of parity, is the concept of network adequacy, or the idea that there are sufficient providers within an area to meet to the needs of the health plan’s beneficiaries. Under the Affordable Care Act, it’s required that health plans participating as qualified health plans in the marketplace meet network adequacy standards.

“Failing to meet network adequacy is one of several ways that a health plan can fall short in meeting parity requirements and effectively discriminate between med/surg care and mental health or addiction treatment,” says Harry Nelson, JD, founder and managing partner of Nelson Hardiman, a Los-Angeles based law firm that focuses on healthcare regulation.

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