Best intentions of Georgia 2022 behavioral health insurance law fall short with slow implementation

Rome Republican state Rep. Katie Dempsey has filed a bill that aims to close the gaps in enforcement of Georgia's 2022 landmark mental health law. Dempsey is seen here presenting her bill in committee Thursday. Jill Nolin/Georgia Recorder

State leaders celebrated three years ago when they passed a bipartisan measure designed to step up enforcement of a federal law that requires health insurers treat mental health and substance abuse services the same as physical care.

But more than two years after that law took effect, lawmakers and advocates are voicing frustration with the state of enforcement of behavioral health parity rules passed in 2022 that were intended to improve access to care in Georgia.

Gov. Brian Kemp signed a celebrated bipartisan mental health reform bill into law on the last day of the 2022 legislative session. Ross Williams/Georgia Recorder (file photo)

"It's fine to pass legislation, but if the legislation just stays on the books and is not implemented, we don't help anybody," Eve Byrd, director of the mental health program at the Carter Center, said at a recent press conference at the state Capitol.

Former first lady Rosalynn Carter, who died in late 2023, was a major champion of behavioral health parity. Byrd said the Carter Center remains committed to seeing "full implementation" of Georgia's law, which she called national model legislation.

The Atlanta-based center has launched public awareness campaigns in Albany, Savannah and Atlanta to help people understand their rights and what they should expect from the health insurer.

But Byrd and others are calling on the state to do its part to hold insurers accountable when these companies throw up roadblocks for receiving mental health and substance abuse treatment services.

Under the law, deductibles, co-pays or limits on the number of visits or days of hospitalization should be the same for mental and physical services.

"People are dying. People are not getting the care they need," Byrd said.

So far, the state is receiving few complaints about suspected parity violations, but advocates say that may have more to do with low awareness about the care patients are entitled to, an online complaint portal that can be difficult to navigate, and the state's slow ramp up of enforcement provisions.

Need to report a parity violation? If you have private insurance, you can file a complaint here. If your insurance is through Medicaid, complaints can be filed here.

"That's part of the problem is we don't even know. The data is not clear as to what insurers are doing well and what insurers are not doing well," Byrd said. "So, you can't really point fingers or implement penalties. So that is a real first step."

Laura Colbert, executive director of Georgians for a Healthy Future, which is a patient advocacy organization, described the implementation of the 2022 law as "uneven" at a parity day event in mid-February.

Colbert said the insurers' reports to the state are not demonstrating compliance with the law, adding that the reports on private insurance coverage vary in quality. She said the reports on coverage through Medicaid are better, partly because the state Department of Community Health uses a standardized template for reporting.

"For parity to become so real, the onus is on insurance companies. The other portions of this law are very important for holding them accountable, because they certainly will not police themselves, but insurance companies should be doing the work of parity," Colbert said.

Rep. Mary Margaret Oliver (left), a Decatur Democrat, and Eve Byrd, director of the mental health program at the Carter Center, talk about Georgia's landmark mental health law at a parity day event in February. Jill Nolin/Georgia Recorder

But she said state agencies are "important accountability partners." Insurance Commissioner John King, whose office oversees private insurance plans, and the state Department of Community Health, which administers the state's Medicaid program, are the main agencies tasked with making the 2022 law a reality.

How to enforce parity rules in Georgia was the focus of the final negotiations over the landmark bill three years ago, says Rep. Mary Margaret Oliver, a Decatur Democrat who was a co-sponsor. She's among the lawmakers pushing this year for more "enforcement muscle."

"We have it on paper, but our enforcement processes are working in hit and miss and not satisfactory to my opinion," Oliver said.

Oliver said even with the scant data there is evidence of insurance barriers in place for behavioral health treatment in Georgia that are not in place for physical care, such as unequal rules for requiring providers to get approval from an insurer before prescribing medication.

'We should not have to be here for this bill'

There's a proposal on the move this legislative session that aims to close the gaps in enforcement.

"This is a measure to actually strengthen the oversight of mental health insurance coverage in Georgia by holding insurers accountable for parity compliance," said Rome Republican state Rep. Katie Dempsey, who is sponsoring the bill and who chairs the House budget subcommittee for human services.

"This bill is a significant step forward, ensuring that mental health care is treated equally to physical health care with the insurance system in Georgia," she said.

The bill would create a formal mechanism to review and address complaints through a proposed parity compliance review panel, and it would require health care providers to report suspected violations by health insurers.

"This mandatory reporting of mental health parity violations is so very important for us to get the data that we need to understand what we are meeting, how close we are to that threshold, and then how to get there as well," she said.

Kevin Tanner, commissioner of the state Department of Behavioral Health and Developmental Disabilities, speaks at Addiction Recovery Awareness Day in 2024. Jill Nolin/Georgia Recorder (file photo)

Kevin Tanner, who is the commissioner of the state Department of Behavioral Health and Developmental Disabilities, said Wednesday that he thinks leaning on providers to help report violations – rather than waiting on the patient to submit a complaint – will help the state get a better handle on enforcement.

"I think part of the challenge is individuals may not even know that there may be a parity violation, they may not know that they've not received a service that under the law they should be receiving," Tanner said. "So I think that's a part of the challenge, because there's not been a lot of violations reported."

If violations are found, the panel will recommend punitive actions to King, who is elected, and the appointed commissioner of community health, Russel Carlson.

The panel would be able to receive and evaluate complaints reported by the providers, and it would also be empowered to analyze reports from health insurers and to request information regarding potential parity violations, including determinations of "medical necessity."

And the panel would also be tasked with creating and reviewing "culturally and linguistically sensitive" educational materials about behavioral health parity for consumers and health care providers.

If funding is made available later, the panel would be assisted by staffers.

The panel would be attached to the existing Behavioral Health Coordinating Council within the state Department of Behavioral Health and Developmental Disabilities. The bill would also add the insurance commissioner to the council.

Dempsey's bill includes recommendations that were included in the latest report from the Behavioral Health Reform and Innovation Commission, which was a big driver behind the 2022 law.

"We support this bill very much, but we should not have to be here for this bill," Jeff Breedlove with the Georgia Council for Recovery said to lawmakers Thursday.

"Families across Georgia, working class families who do not have the time or the money, are encountering roadblock after roadblock, hurdle after hurdle to save a life," he said. "So, every day we delay, every other meeting we have to go to, in the world we understand we get it, but for working class families, it's Russian roulette with the life of their loved one."

Dempsey's bill was voted out of committee last week. It has until this Thursday, which is Crossover Day, to pass the full House to have the smoothest path to the governor's desk. The legislative session ends April 4.

An attempt to reach King for comment through his office was not successful.

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