Madison Lawmaker's Mental Health Equality Legislation Signed into Law

From Connecticut State Democrats:

HARTFORD, CT - Senator Ted Kennedy, Jr. (D-Branford) has announced that one of his highest legislative priorities has been signed into law; SB 131, a bill he introduced to require health plans to disclose limitations on beneficiaries’ mental health and substance abuse coverage that may not apply to other forms of medical treatment. With a strong bipartisan backing, the bill passed unanimously out of the State Senate and by a vote of 122-23 in the House of Representatives. Senate Bill 131, now Public Act 16-158, takes effect immediately.

“This law is a response to the countless families from across Connecticut who have told me that health plans are still refusing to pay for mental health treatments,” said Senator Kennedy, a member of the General Assembly’s Public Health Committee and a health care and disability rights attorney. “Doctors and hospitals are frustrated and upset that they cannot get needed mental health and addiction services approved for their patients. By requiring better transparency on reimbursement data, which health plans already collect but do not always disclose, we will be able to determine if an unfair pattern of unreasonable denials actually exists across the industry. This information will enable the legislature to determine whether further action is needed to ensure that Connecticut citizens that stand to benefit from mental health coverage reforms are not short-changed. Without good data, parity laws will be very hard to evaluate and enforce.” 

Prior to recent developments in federal and state insurance law, health plans routinely restricted mental health coverage and reimbursement in ways that did not apply to coverage for other medical conditions, such as for heart disease, diabetes and cancer. While most health plans have now eliminated the obvious differentials in plan design features such as copays and deductibles, there is strong anecdotal evidence to suggest that the number of pre-authorization requests and denials for mental health services still far outpace the number of pre-authorization denials for other conditions.  PA 16-158 aims to determine if mental health and addiction services are indeed being denied by insurers at a significantly higher rate when compared to other forms of medical care. If denial rates are not comparable, such practices would violate mental health parity laws.

Recent investigations into New York State insurance companies by Attorney General Eric Schneiderman revealed that many health plans doing business in New York denied substance abuse treatment and psychiatric services at twice the rate than for medical/surgical claims. One large Blue Cross Blue Shield affiliate denied inpatient substance abuse recovery services seven times as often as inpatient medical services, and agreed to a legal settlement valued at over $9M. If similar market conditions exist in Connecticut, the state’s residents will not be able to access these services. This would also dramatically reduce Connecticut’s ability to address our growing addiction epidemic.

During a public hearing for this bill earlier this year, multiple Connecticut medical professionals testified that they have encountered a concerning amount of resistance from health insurers when trying to get mental health care for patients.

Dr. Reena Kapoor, President of the Connecticut Psychiatric Society, representing over 800 Connecticut psychiatrists, testified “Our members report that patients seeking mental health care through commercial insurers are routinely denied coverage for medically necessary treatment in ways that appear to violate parity laws. This legislation will help provide much-needed transparency about how insurance companies make decisions about the coverage of behavioral health services. Until we are able to directly compare data about the coverage of mental health and physical illness, patients seeking mental health care remain at risk, and we won’t get the answer as to whether true parity exists in Connecticut.”

Dr. Caren Teitelbaum, a senior staff psychiatrist at the Institute of Living, a psychiatric facility in Hartford, testifying in support of the bill, spoke about the need for objective data, saying “There is at least a significant question whether mental health parity violations are occurring. This is an important step in the continued effort to ensure that patients with psychiatric illnesses receive adequate and equitable care.”

Dr. Laine Taylor, representing the Connecticut Council of Child and Adolescent Psychiatry, testified, “This bill will help mitigate serious barriers to treatment caused by the excessive use of pre-authorization requirements. We need to turn anecdotal evidence into usable information that will assist in accomplishing mental health parity.”