Insurance and Real Estate Committee

JOINT FAVORABLE REPORT

Bill No.:

HB-6887

Title:

AN ACT CONCERNING MENTAL HEALTH CARE SERVICES AND SUBSTANCE ABUSE SERVICES PROVIDED BY CERTIFIED PEER COUNSELORS.

Vote Date:

3/15/2017

Vote Action:

Joint Favorable Change of Reference to Public Health

PH Date:

2/16/2017

File No.:

SPONSORS OF BILL:

Insurance and Real Estate Committee

Rep. Cristin McCarthy Vahey, 133rd Dist.

REASONS FOR BILL:

Currently, private insurance coverage does not always cover certified peer counselors and only does so in public insurance through a grant to the Department of Mental Health and Addiction Services. This bill would change that and make it so that private insurance companies need to develop plans that would reimburse peer support specialists and case managers for their work in mental health and substance abuse services.

Substitute Language

Changes the language in the bill from “shall” to “may” under section 2 and section 3 dealing with how the Insurance Commissioner may adopt regulations to implement each respective section regarding individual and group health insurance covering peer support services.

RESPONSE FROM ADMINISTRATION/AGENCY:

State of Connecticut Insurance Department opposed the bill as unnecessary due to existing laws that require carriers to provide medically necessary coverage for mental or nervous conditions. They stated that this coverage includes treatment for mental and nervous conditions which also includes substance use disorder. They also noted the Department's Consumer Affairs Division is always ready to assist consumers who believe the mental health or substance abuse treatment received was not covered adequately.

Rep. Cristin McCarthy Vahey, 133rd Dist. Supported the bill and testified that individuals accompanied by a team of at least a peer support specialist and a case manager, have a better chance for long term recovery.

NATURE AND SOURCES OF SUPPORT:

Chelsea Boska (McIntosh), Psychiatrist testified that a lot of work she does for her clients involves case management outside of her work sessions and that with this bill, she can refer her clients to a case manager who can then bill for services rendered. She stated that this would free her work schedule in a manner that would allow for more focused care for her clients.

Vered Brandman testified that the bill would allow for peer support services to bill their clients and therefore receive reimbursements from the insurance companies. He also testified that Peer Support Specialists are here to compliment the system and not to take jobs away from other professionals.

Tina M. Corlett supported the bill and stated that this will help individuals navigate the already complex system by granting reimbursements for those who understand the system from firsthand experience.

Marcia DuFore, Executive Director, North Central Regional Mental Health Board

Testified the bill provides reimbursements for peer support counselors and that they have personal experience with the system to help others as they navigate the system. She went on to say that this bill is especially important because DMHAS grant funded services are slated to be cut by $4.7 million by the Governor's budget proposal. Lastly, she noted that roughly $500,000 was cut last year for peer services.

Dianela Giordana, MSW, Public Policy Director, NAMI Connecticut supported the legislation and noted that there are two certifications for two kinds of peer supports. The first one is an 80 hour certifications through Advocacy Unlimited for those who have experienced mental health matters to become a Recovery Support Specialist. The other one is offered by the CT Community for Addiction Recovery for those who have experienced addiction issues and become certified Recovery Coaches.

Michael Mackniak, Chief Operating Officer, Guardian Ad Litem Services, Inc. testified that by expanding what defines case management and including care coordination as covered services, the quality of life would increase for many throughout the state.

Kati Mapa, Interim Executive Director, Eastern Regional Mental Health Board testified that those with private insurance should have the same access to supports that are available to those with public insurance.

Northwest Regional Health Board, Inc. testified in support of the bill by stating that coverage for peer support specialist are available to those with public coverage under DMHAS funded programs and that those with private insurance should have the same options as well.

Jeanne Proctor supported the bill and noted their son has schizophrenia and the help from peer support specialists and peer groups have been significant in their son's life.

Marc Rabinowitz testified that peer support services are currently available in every state and Medicaid reimbursable in 35 states. He stated that these services can lead to a decrease in length of hospital stays, reduce symptoms and hospitalizations, and encourage longer-lasting recoveries.

Marisa Rambush, Peer Support Specialist, Milford Division of the CT Strong Grant testified that bill is an important step in addressing mental health and addiction in the state. She went on to say that currently there is no definition of what a peer support specialist is and that with the introduction of insurance companies; a clearer job description and insurance coverage would both work to legitimize the work of a peer support.

Valerie Sacco testified that the cost of insurance to cover these services are less expensive than hospital stays and many other health services.

Michael Scanlon

Susan Buchsbaum

Both submitted similar testimony supported peer support specialists and indicated they wanted to see insurance coverage expanded to cover these costs listed throughout the bill's language. They stated the peer support specialists are a great community resource and play an important role for those working through recovery.

Elsa Ward, Assistant Director, South Central Peer Services, Continuum of Care, New Haven supported peer support specialists and wanted to see insurance coverage expanded to cover these costs. She stated that she would like to see peer support specialists go through an intensive training program and certification and also that case managers have a Bachelor's degree.

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

supported peer support specialists and wanted to see insurance coverage expanded to cover these costs. Testified that the cost of insurance to cover these services are less expensive than hospital stays and many other health services. She stated that many people in Connecticut rarely see the benefits from peer support specialists because many insurance companies do not cover the peer support specialists.

Mary Jane Williams Ph.D., RN, Chairperson, Government Relations Committee, Connecticut Nurses Association supported peer support specialists and wanted to see insurance coverage expanded to cover these costs. He also cited a number of statistics that detailed the lack of services available for mental health patients have available in the state. He noted that an avenue to deal with this is to increase the amount of work peer special supports can provide by requiring insurance coverage for their work so they can be reimbursed.

NATURE AND SOURCES OF OPPOSITION:

Greg Benson, Director of Policy, Advocacy Unlimited, Inc.

Paul D. Acker, Director of Recovery University

Both expressed concern over the bill and the language used to define “peer support” and how much latitude it gives to insurance companies to determine what actually counts as “peer support”. He testified that this bill does not protect peer support from co-option and would like to see matters worked out in the bills language before supporting it.

Anthem Blue Cross and Blue Shield in Connecticut expressed concern regarding all bills, this one included, that pertain to health insurance and asked that the committee refrain from passing any legislation until the Congress has acted on the Affordable Care Act in Washington D.C.

Cheri Bragg expressed dissatisfaction with the bill and in particular how it uses the term “case management”. He went on to say that traditional “case management” has not been effective for individuals with mental health and substance abuse for wellness or recovery. He testified that “case management” tends to advocate a dependency on the system and the case managers instead of promoting self-empowerment.

Connecticut Association of Health Plans objected to the bill by how it issues an additional mandate on private insurance companies. They went on to say that this would limit the flexibility an insurance company has in terms of how it constructs benefit packages for consumers.

Michaela I. Fissel

Latosha Taylor

Both testified that by requiring insurance companies, provider networks, and hospital associations to define peer support service, it will become another business transaction. They went on to say that when this becomes purely a business transaction, the effectiveness of this particular support service will be diminished.

Daniel C. Giungi, Senior Legislative Associate, Connecticut Conference of Municipalities (CCM) wanted the committee to hold all proposals until a detailed fiscal analyses was done to see the implications the bill would have on towns and cities as this is an additional mandate on increased insurance coverage.

Natacha Kereljza liked the intent of the bill and peer support services but expressed concern over expanding this service through insurance coverage.

Joanie Masot, Certified Recovery Support Specialist, Advocacy Unlimited Inc. expressed concern over the language in the bill and asked the committee to not permit the peer support's value to be diminished by allowing the services to become entwined in the insurance infrastructure.

Celeste Mattingly, LCSW testified the training peer support advocacy groups receive cannot compare to what professional counselors have to do in order to become licensed. She stated that this is undervaluing the licensed professional community and urged the committee to oppose the bill.

Reported by: Stephen Sanabria, Assistant Clerk

Date: March 29, 2017