May 26, 2024

Sen. Ujifusa, Rep. Tanzi introduce bills to help patients with mental health and substance use disorders

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State House – Sen. Linda Ujifusa and Rep. Teresa Tanzi have introduced two bills to address problems faced by those with mental health or substance abuse problems: lack of parity between mental and physical health care insurance coverage, and denial of prior authorizations by insurers.

Says Senator Ujifusa (D-Dist. 11, Portsmouth, Bristol), “There is no question that since COVID, mental health and substance abuse problems have been increasing among people of all ages and demographics. If we don’t address these problems today, we’ll face more serious and expensive problems later.”

The first bill (2024-S 2612, 2024-H 7876) would specify the insurance coverage standards, protocols and guidelines for treatment of individuals with mental health or substance abuse use disorders. It is based on a model parity bill developed by The Kennedy Forum in partnership with the American Psychiatric Association and more than 30 additional national organizations. So far, four states have adopted the legislation in full – California, Illinois, Georgia, and Oregon.

“Despite a 2008 federal law that requires insurance coverage for mental health conditions, including substance use disorders, to be no more restrictive than insurance coverage for other medical conditions, insurers can routinely deny critical mental health treatment based on their own rules, which are designed to minimize patients’ use of care,” said Representative Tanzi (D-Dist. 34, South Kingstown, Narragansett). “If you wake up from a diabetic coma, your insurance will cover continuing care for your diabetes. But a person can be hospitalized for an overdose and be denied coverage for substance dependency treatment. Both cases are life-threatening health issues that warrant care, but they are not always treated equally by insurers.”

Explains Mental Health Association of RI (MHARI) Executive Director Laurie-Marie Pisciotta, “Many insurers develop their own ‘medical necessity’ guidelines, which can vary greatly from plan to plan, and need not align with what providers believe is in the best interest of their patients. This can result in behavioral health problems, such as depression or anorexia, too often being viewed as acute problems that do not require longer-term care.”

The legislation specifically prohibits insurers from limiting benefits or coverage for chronic or pervasive mental health and substance use disorders to short-term or acute treatment.

In Rhode Island, the bill is supported by MHARI, RIPIN, Newport Mental Health, Protect Our Healthcare RI, Rhode Island Medical Society, Lifespan, Rhode Island Psychological Association, the Economic Progress Institute, and behavioral health care providers.

The second bill (2024-S 2393, 2024-H 7624) would prevent insurers from requiring that patients obtain prior authorization before seeking in-network mental health or substance use disorder health care.

Blue Cross Blue Shield of Rhode Island (BCBSRI) proactively dropped its preauthorization for such services in 2018, and the sponsors introduced the bill to require other insurers to follow suit.

“BCBSRI has had this policy for years and likely saved money because it was not blocking early access to behavioral health care,” said Representative Tanzi. “There is no evidence that other insurance companies would face hardships in complying, and this bill is supported by the Office of the Health Insurance Commissioner, the Department of Behavioral Health and Developmental Disabilities and Hospitals, as well as MHARI, RIPIN, Lifespan, Newport Mental Health and behavioral healthcare providers.”

Both bills been held for further study by the House Health and Human Services Committee, and will be heard in the Senate Health and Human Services Committee in the coming weeks at a date to be determined. Senator Ujifusa and Representative Tanzi urge patients and their advocates to testify in person, and submit testimony by email with the subject line “In support of S2612/H7876 and S2393/H7624.” Written testimony should describe why the writer supports the bills, including challenges caused by lack of parity and prior authorization requirements. Send testimony to the Senate HHS Committee to SLegislation@rilegislature.gov  and to the House HHS Committee to HouseHealthandHumanServices@rilegislature.gov

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