Colorado lawmakers target 'ghost networks' to expand access to mental health care

A few years ago, the U.S. Senate Committee on Finance conducted a "secret shopper" survey on health insurance plans across six states, including Colorado.

Of the 120 providers called, one-third were either inaccurately listed in the carrier database, out of service, or did not return the call. Only half of all calls to providers in Colorado resulted in an appointment.

The Senate panel had encountered what are known as "ghost networks" — providers listed in a health insurance database as in-network but unable to provide care because they're out of network, not accepting new patients, moved, or no longer in business.

This year, state lawmakers are hoping to make it easier for Coloradans to access mental and behavioral health care providers within their insurance networks by cracking down on these "ghost networks" that, they said, have inundated provider directories.

Under House Bill 1002, commercial insurance carriers would be required to check in with mental and behavioral health care providers who haven't submitted a claim for at least a year to confirm that they're still in network and accepting new patients.

The bill also requires insurance companies to admit pre-licensed providers to their networks and to reimburse those providers for services rendered under the supervision of a licensed professional.

Additionally, the measure aims to boost the mental health workforce by reducing the number of hours required for an individual to become a licensed clinical social worker from 3,360 to 3,000, according to sponsors.

"Coloradans are 11 times more likely to seek out-of-network therapists than a comparable physical health specialist," said bill sponsor Rep. Lindsay Gilchrist, D-Denver. "This results in higher out-of-pocket costs, delays in care, and other adverse consequences for patients and their families. This is why we're bringing this bill forward today — to take the first step to addressing these pressing issues."

Every one of Colorado's rural counties is facing a mental health workforce shortage, said Rep. Kyle Brown, D-Louisville, who is also sponsoring the bill. It is projected that the state needs more than 4,000 positions in the mental health workforce, and demand is outpacing growth.

"There are too many Coloradans that cannot get the care they need, and at the core of that is making sure that we have an adequate mental health workforce," he said. "We need to be doing everything we can on the private health insurance side to be fighting this mental health crisis and the workforce shortage that we have."

Alexis Althop of Healthier Colorado called the bill "a significant step in alleviating the burden of trial and error for patients."

"Ensuring inaccurate providers are removed from networks in a timely manner will help create space for these providers that are eager to join the networks and accept new patients," Althop said.

Althop said the bill would also significantly help pre-licensed and early-career mental health professionals, who often have difficulty gaining acceptance into provider networks due to unpredictable credentialing timelines, unclear participation requirements, and inconsistent reimbursement.

Access and affordability issues are rampant across the spectrum of health services, Amanda Carlson of the Colorado Consumer Health Initiative said, but finding and receiving mental health care is especially challenging.

"Navigating the health care system can be difficult enough without having to chase down providers within their ghost networks for time-sensitive care," she said.

The bill passed on a 10-2 vote with Reps. Brandi Bradley, R-Roxborough Park, and Dan Woog, R-Erie, voting in opposition but saying they hope to get to a position where they can vote in favor of the measure when it comes to the House Floor.

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