Dear Advocates,

Thank you for following along with another successful Indiana Legislative Session!

The 2020 Indiana General Assembly has adjourned sine die, with numerous bills considered in the area of behavioral health. Several bills passed and will be highlighted here, but maybe none more significant that HB 1092.

Mental Health America fought for parity in insurance coverage that includes financial requirements and treatment limitations for behavioral health coverage as compared to physical health. MHAI passed mental health parity legislation in Indiana that was followed by federal legislation, then later incorporated into the Affordable Care Act. The federal parity law, the Mental Health Parity and Addiction Equity Act (MHPAEA), includes rules that encompass provider payment rates and network adequacy. Unfortunately, it would appear that the parity law has not been implemented as intended. According to a recent report by Milliman, disparities exist in both network use and provider reimbursement levels, when comparing behavioral healthcare to medical/surgical healthcare. Significant disparities, such as high out-of-network use of behavioral health providers and/or lower reimbursement for behavioral providers, could point to compliance problems. Health plans must be carefully reviewed in order to ensure compliance with mental health parity.

Milliman found that out-of-network utilization rates of behavioral health providers were higher than medical and surgical providers from 2013 through 2017. In 2013, a behavioral health provider was 2.8 times more likely than a medical provider to see a consumer who was going out of network. That disparity increased to 5.2 times more likely in 2017. In 2017, 17.2% of behavioral health office visits were to an out-of-network provider compared to 3.2% for primary care and 4.3% for a specialist.

Compounding the problem is that reimbursement rates for behavioral health providers were far below medical and surgical office visits. In 2017, primary care reimbursements were 23.8% higher than behavioral health reimbursements, an increase from 20.8% in 2015. In 2017, reimbursement rates for primary care office visits were more than 50% higher than reimbursement rates for behavioral office visits in 11 states, an increase from nine states in 2015.

Conference Committee Report for HB 1092, Chaired by Representative Ziemke, includes parity language from SB 208, authored by Senator Crider in the Senate and sponsored by Representative Kirchhofer in the House, would respond to these concerns.

HB 1092 will: (1) Require an insurer to annually submit a report and analysis to the Department of Insurance (DOI) that includes certain information demonstrating its compliance with federal laws regarding parity in coverage of services for treatment of a mental illness or substance abuse and coverage of services for treatment of other medical or surgical conditions, including the processes used: (a) to develop medical necessity criteria for coverage of services; and (b) to develop and apply nonquantitative treatment limitations. (2) Requires the DOI to adopt rules to ensure compliance with federal laws regarding parity in coverage. (3) Requires the DOI to submit before March 1, 2021, a report to the General Assembly detailing the steps taken to ensure insurers' compliance with state and federal laws regarding parity in coverage. (4) The bill prohibits limitations on nonquantitative treatment of mental illness substance abuse that do not apply to medical or surgical coverage treatment within any classification of benefits.

Mental Health and Addiction Parity, if implemented as intended, would eliminate the discriminatory practices that some individuals with mental illness and addiction disorders have endured with their insurance coverage. HB 1092 will assist Indiana in implementing mental health parity as it was intended when passed.

Stephen C. McCaffrey, JD
President and CEO of Mental Health America of Indiana
Senate Bill 273 establishes the  In diana behavioral health commission. Specifies the membership of the commission. Requires the commission to prepare: an  in terim report not later than October 1, 2020; and a final report not later than October 1, 2022. Specifies the issues and topics to be discussed  in  the commission reports,  in cluding: to conduct an assessment of behavioral health  in   In diana; to evaluate barriers to mental health and substance use disorder treatment  in   In diana; to evaluate other state and national mental health programs; as well as to review and make recommendations regarding funding levels for mental health programs and services. Requires commission reports to be issued to the following parties: (1) The governor. (2) The legislative council. (3) Any other party specified by the commission chairperson.

Senate Bill 246 Requires a school corporation, charter school, or accredited nonpublic school to certify to the department of homeland security that a school corporation, charter school, or accredited nonpublic school has a memorandum of understanding in place with a community mental health center or provider certified or licensed by the state to provide mental and behavioral health services to students before applying for a grant from the Indiana secured school fund. 
House Bill 1283 requires a teacher preparation program to include content within the curriculum that: (1) prepares teacher candidates to use evidenced based trauma informed classroom instruction and recognition of social, emotional, and behavioral reactions to trauma that may interfere with a student's academic functioning; and (2) provides information on certain applicable Indiana laws. Requires a teacher preparation program to consider using certain curricula pertaining to student trauma.
House Bill 1346 specifies the purpose and certain duties of the Justice Reinvestment Advisory Council, including: to conduct a state level review and evaluation of jail overcrowding to identify a range of possible solutions; and to develop incarceration alternatives and recidivism reduction programs at the county and community level by promoting the development of the incorporation of evidence based decision making into decisions concerning jail overcrowding. Provides that the advisory council may make a recommendation to the county sheriffs concerning strategies to address jail overcrowding and implementing evidence based practices for reducing recidivism for individuals in county jails.
House Bill 1182 requires a syringe exchange program to:(1) provide testing for communicable diseases and provide services or a referral for services if the individual tests positive; and (2) establish a referral process for program participants in need of information or education concerning communicable diseases or health care. Requires the state department of health to include certain information concerning syringe exchange programs in the report to the general assembly before November 1, 2020. Extends the expiration date for certain syringe exchange programs from July 1, 2021, to July 1, 2022. Defines certain terms. Makes conforming amendments and technical corrections.
Senate Bill 1 prohibits a person who is less than 21 years of age from buying or possessing: (1) tobacco; (2) eliquids; or (3) electronic cigarettes. Makes conforming changes regarding enforcement provisions, sales certificates, prohibition of delivery sales, and notices posted at retail establishments and at vending machines. Provides that a retail establishment that sells an eliquid to a person less than 21 years of age is subject to a civil judgment for an infraction. Doubles the civil judgment for an infraction for: (1) a retail establishment that sells or distributes tobacco, an eliquid, or an electronic cigarette to a person less than 21 years of age; and (2) certain retail establishments that allow an underage person to enter their establishment.
Among many new changes to our policy agenda, the following are a few highlighted areas of focus:

  • MHAI will support efforts to increase the price of tobacco and e-liquid products through taxes or other means such as raising the age of use of tobacco and e-liquids products to 21 in an effort to decrease utilization of all tobacco products.

  • By providing the opportunity for schools to offer behavioral health programing with funding to increase capacity, schools can develop and maintain partnerships with community mental health service providers and create a safety net for those students and their families who may otherwise not receive the services they need. Most importantly, services in schools provide the opportunity for early intervention and prevention.  

Click the link below to see Mental Health America of Indiana's full public policy agenda.
Join Mental Health America of Indiana for our next upcoming event!

Want to learn about today's accredited research and programming in mental health and substance use? Join Mental Health America of Indiana for our annual Mental Health Symposium on May 28, 2020 at the Crown Plaza at Union Station. This year's Plenary Speaker is Indiana FSSA, Cheif Medical Officer, Daniel E. Rusyniak, MD. his expertise includes the study and prevention of complications from drug abuse. His work has been shaped, in part, by growing up in Appalachia, the heart of the opioid epidemic.

Questions? Comments? Concerns? Please contact our event coordinator, Rebekah Gorrell .
The Mental Health America of Indiana staff thanks you for joining another successful Hoosier Idol event. With your help, we raised over $60,000 to further support Hoosiers in their path to mental wellness and recovery!
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