Lawmakers hear testimony on Truth in Mental Health Coverage Act

Feb. 10—OLYMPIA — A bill to streamline access to mental health has been introduced in this year's session of the Washington Legislature.

House Bill 2658 and its Senate counterpart, SB 6305, dubbed the Truth in Mental Health Coverage Act, would require health insurance carriers to keep publicly available data on the coverage and access they provide in a given area to mental health and substance abuse services. That data would be lined up next to the same data regarding medical and surgical care and other services provided by the carrier.

This addresses a very real problem, witnesses told the House Health Care and Wellness Committee during a Feb. 3 hearing.

"Across Washington, families and employers pay premiums and are promised behavioral health coverage," said Cara Cheevers, vice president of coverage policy for Inseparable, a nonprofit that seeks to close the coverage gap for mental health and substance abuse disorders. "But when families try to use that coverage, they find it's not there when they need it. Inadequate reimbursement in networks make in-network care hard to find, forcing families out of network, where they face much higher out-of-pocket costs. Washington data shows how serious this is. Out-of-network use is seven times higher for outpatient behavioral health care than for physical health care and 16 times higher for inpatient care. Many families, unfortunately, have to forego care until problems become crises."

Health insurance providers frequently promise one thing and deliver another, said Jane Beyer, senior health policy advisor for the Washington State Insurance Commissioner's Office.

"When we think about mental health or behavioral health parity compliance, we sort of put it into two buckets," Beyer said. "One bucket is what's written on the piece of paper and the policies that the insurance company has, and (the other is) how do those policies actually play out in reality? We call that as-written and in-operation. Essentially, House Bill 2658 applies transparency to that in-operation component of parity compliance, how access to behavioral health services compares to medical services. We really think that having and maintaining this information on a public website gives employers (and) individuals the information that they need so they can think about what the best health plan is for them given their needs."

The question of parity between medical and mental health care isn't so cut and dried, however, according to Kathleen Wedemeyer of the psychiatric watchdog group, the Citizens Committee on Human Rights, because mental health diagnoses aren't cut and dried either.

"These (diagnoses) are not based on medical causes but on subjective, personal interpretation of behavior as disease. Unlike our definitions of ischemic heart disease, lymphoma or AIDS, (mental health) diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic symptoms based on the nature of chest pain or the quality of fever."

Darcy Huffman, representing the National Association of Social Workers, came out in strong support of the bill.

"Despite insurance coverage, accessing mental health and substance use care can be difficult," Huffman said. "Individuals often find that care is not readily available within their insurance networks. This leads to many patients having to seek mental health care out of network, which leads to higher personal costs. These increased costs create financial barriers, leading some individuals to either foregoing necessary treatment or incurring significant expenses. Unaddressed mental health issues can result in higher overall health care costs due to untreated conditions that may worsen. How many bills have we heard this session regarding the devastating effects of medical debt on individuals and families? ... Health care insurance is one of the most important and expensive decisions we make as Washingtonians. We should be given as much relevant information as possible so we can make the best decisions for ourselves and our families."

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