Insurance and Real Estate Committee

JOINT FAVORABLE REPORT

Bill No.:

SB-1085

Title:

AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR MENTAL OR NERVOUS CONDITIONS.

Vote Date:

3/19/2015

Vote Action:

Joint Favorable

PH Date:

3/17/2015

File No.:

SPONSORS OF BILL:

Insurance and Real Estate Committee

REASONS FOR BILL:

This bill will provide that commercial individual and group Insurance cover services designed to treat mental and nervous conditions, including psychiatric inpatient and outpatient care, partial hospitalization and intensive outpatient services, extended day treatment, rehabilitation services in group homes and community-based settings, Emergency Mobile Psychiatric Services, and several other service options.

RESPONSE FROM ADMINISTRATION/AGENCY:

State of Connecticut Insurance Department The “Department” (Insurance) appreciates the intent of this bill but they are concerned that this bill might be classified as a new mandate. The department consulted the Center for Consumer Information & Insurance Oversight which oversees the implementation of the Affordable Care Act. They deemed that the section that would require a 14 day treatment would be considered a new mandate under the ACA and would therefore require the State of Connecticut to defray the costs.

Victoria Veltri, Healthcare Advocate, Office of The Healthcare Advocate testified thanking the committee for introducing this bill. This bill will benefit consumers by creating uniformity in the coverage of mental health conditions across public and private health plans. SB 1085 “supports effective treatment through its deference to the members treating provider by requiring health plans to cover medically necessary inpatient and acute treatment for fourteen days without prior authorization”. This is very important because when treatment is denied coverage early in the process because of costs, there is a much greater risk of relapse and recurrence of the original symptoms. This bill promotes access to transparent, quality, and cost-effective treatment for our citizens.

Miriam Delphin-Rittmon, Ph.D, Commissioner, The Department of Mental Health and Addiction Services testified giving a neutral stance on this bill. The Department applauds the committee for raising this bill; however there are fiscal consequences due to this legislature also. This will be considered a new mandate and pose a significant cost to the state, “we respectfully ask that the Committee carefully contemplates the position of the Insurance Department while considering this legislation”.

Sarah Eagan, Child Advocate, Office of The Child Advocate submitted testimony in support of this bill. This bill will ensure access to critical health services for individuals with mental health needs. We support the need to strengthen access to behavior health services. “This bill also prevents cost-shifting to state funded to state funded program”. This bill doesn't add new mandates to the scope of services covered by commercial payers.

NATURE AND SOURCES OF SUPPORT:

Kristen Tierney, Owner, Turtles & Lemonade testified in support of enabling Mental Health Parity. She has a loved one who has private insurance but very little coverage for the services that are needed for treatment. “Until either insurance practices change or a person passes our loved ones will be back in the ER when in crisis with all of the associated costs to the Healthcare system all due to the industries knowing avoidance of cost-effective, evidenced based, maintenance supports”. Mental health is no different than cancer and just like cancer it needs to be treated with evidenced based care.

Daniela Giordano, Public Policy Director, National Alliance on Mental Illness submitted testimony in support of broadening the scope on commercial state health insurance coverage. People who have private insurance don't have the access they need to deal with their mental health concerns. “Like most other health concerns, identifying mental health conditions early and having access to appropriate services over time not only supports the individuals health and wellbeing, but also benefits the community and state by not allowing health concern to become more severe and thus most often requiring higher level, longer and more costly treatment.

Lori Szczygiel, Senior Vice President, Beacon Health Options testified, she has multiple view points on this topic due to her various roles. The Healthcare Advocate is a strong colleague “in arms” helping improve the delivery system for individuals and families struggling with serious emotional disturbance and other behavioral health challenges. Measures to ensure coverage and access are not enough. The one area that raises a concern is the area that deals with a patients stay for inpatient services and absence of utilization management which we believe to be medical necessity determination. “We want to assure that community base services are used as more restrictive levels of care”. Continue efforts of Payment reform to allow payers and providers to expand the delivery of services. “Additional behavioral health reporting to track data that is needed to inform policy change”. “Continued transparency and dialogue with all stakeholders to continue to move the system forward.

Jan Vantassel, Executive Director, Connecticut Legal Rights Project testified in support of enabling families to gain the access they need to mental health services. This bill will clarify the scope of services covered by state regulated private insurers, by clarifying this people will have more access to evidence based practices.

Wendi Fralick, Senior Director, Mental Health Association of Connecticut testified in support of making mental health coverage more accessible to those who need it. Commercial insurance often does not cover mental health treatment so people are left paying out of pocket. People can be denied coverage altogether because some companies don't deem mental health as medically necessary. This bill advocated coverage that should be provided by state regulated commercial insurers. This bill should “positively impact the overall healthcare system in Connecticut.

Susan Kelley, Child/Adolescent Public Policy Manager, National Alliance on Mental Health submitted testimony in support of expanding the scope of coverage provided by state regulated commercial insurance for mental health services. People with private insurance don't always have access to the coverage they need for mental health services and this bill would help them get the coverage they need. This bill will also help prevent cost-shifting to state programs, provide access to the most appropriate services, and reduce costly hospitalizations. Parents will now have access to in-home mental health services with this bill in place and that would benefit them significantly. We also realize that this bill would cover juveniles with status offenses to address adolescent behavioral problems and substance abuse.

Dr. Harold Schwartz, Psychiatrist in Chief, Institute of Living submitted testimony addressing the discrimination that individuals have to face who are looking for medical treatment for mental health services. The term medical necessity is too ambiguous. This bill would also make sure that people are receiving the care that they need regardless of the cost because they will now be covered, this would eliminate “the protracted and anxiety ridden appeals process for the families of patients denied care and would minimize the huge staff time expense for a review process”. Patients who need care that goes on for an extended period of time are often denied care.

The following also submitted testimony in support of SB 1085

Margaret Watt, Executive Director, Southwest Regional Mental Health Board, INC

Vered Brandman, Consumer Advocate, Norwalk

Lucille Ballentine, Stamford

Marcea Koffsky, Norwalk

Henry J Martocchio, South Windsor

NATURE AND SOURCES OF OPPOSITION:

Connecticut Association of Health Plans submitted testimony in opposition to increasing coverage for mental health services. The state of Connecticut will have more costs because of this bill as well as, “more stress that would be put on inpatient bed capacity given the new 14 day requirement, whether its medically appropriate and to the benefit of a person to remain inpatient for such a long stay, and; whether the intended community providers currently have the ability to integrate into a commercial reimbursement system. “This is not to say that the association is not willing to entertain coverage for these services, only that an additional conversation is warranted prior to committing the policy to statute”.

Reported by: Chris Chinnici

Date: 4/2/15