by Christine Stuart | Mar 5, 2019 7:01pm ( ) Comments | Commenting has expired | Share

Posted to: Insurance, Mental Health Care

HARTFORD, CT — It’s been almost a decade since the federal mental health parity bill was signed into law, but advocates say more needs to be done to ensure those with mental health or substance use disorders are being treated equally for their conditions.

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In order to hold the insurance industry accountable for how the federal parity law is applied in Connecticut both Democrats and Republicans are backing a bill that would require insurance companies to submit annual reports concerning parity for mental health and substance use disorders. The bill would go further in requiring health insurance coverage for prescription drugs prescribed for substance use disorders and would require health insurance coverage of substance use disorder regardless of a court order.

Connecticut’s legislation builds upon the package of laws passed in the wake of the Sandy Hook School shooting, which sought to improve access to mental health and behavioral health services.

Rep. Brenda Kupchick, R-Fairfield, said there are people in Connecticut who are suffering just trying to get help for their family members.

One of those who struggled for years getting help for her son was Dita Bhargava.

Bhargava, who recently ran for governor and then state treasurer, lost her 26 year old son, Alec to an accidental overdose in July.

She said in one of her last conversations with her son she asked him how she should address his disease if the question was asked of her while campaigning.

“Alec told me that I should be honest and that everyone should know about the struggles he’s had to endure from a disease that’s taken the lives of so many of his young friends. A disease he wanted our leaders and health advocates to pay attention to and help with the same intensity that they would if he was battling cancer,” Bhargava said.

But based on the stories parents and advocates told Tuesday parity seems to be elusive.

Former U.S. Rep. Patrick Kennedy, a renowned mental health advocate, said a federal court decision released Tuesday highlights just how far away Connecticut and the rest of the nation is from parity.

A federal court decision from Northern California found that United Behavioral Health (UBH), which serves over 60 million members, denied claims based on internally developed medical necessity criteria. The court found the criteria UBH used were far more restrictive than generally accepted standards for behavioral health care.

Kennedy said that decision, released hours before a public hearing on the bill, was all about insurance companies substituting their own criteria for what is generally accepted medical criteria.

“You in Connecticut, through the Sandy Hook law, made it very clear that all mental health in this state was to follow and adhere to generally accepted medical standards in addiction and mental health care,” Kennedy said. “This law talks in some very detailed ways about transparency and disclosure.”

He said the bill Connecticut is looking to pass requires insurance companies to look at the facts and determine whether they are complying with the non-quantitative treatment limitation requirements of the federal parity law.

According to a Milliman study, Connecticut insurance companies are reimbursing primary care doctors 39 percent more than they are behavioral health providers. That disparity is disadvantaging people who have behavioral health conditions.

“We have a biochemical illness and we are talking about age-old myths that have to be smashed through the enforcement of an insurance law,” Kennedy said.

He said insurance companies manifest that discrimination based on how they operate.

The Connecticut Association of Health Plans said Connecticut already has a robust set of laws that help expedite requests for behavioral health and substance use disorder coverage.

The Sandy Hook law reduced the amount of time an insurance company has to respond to a request for behavioral health services from 72 hours to 24 hours.

By law insurance companies must currently use documented clinical review criteria based on sound clinical evidence to review the requests for coverage.

The Connecticut Association of Health Plans, which represents the insurance industry, said it welcomes the opportunity to work with the committee on legislation that doesn’t set up a system of dual regulation that adds confusion and costs to the system. But it doesn’t support the provision on prescription drugs because it would increase costs and “have the unintentional effect of reducing access to care.”

Tim Clement with the American Psychiatric Association said Connecticut’s legislation is similar to legislation passed in Delaware, the District of Columbia, Illinois and Tennessee.

“This legislation puts the burden of proving compliance on the insurers,” Clement said.

Similar legislation made it through the Senate last year, but died on the House calendar.