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