The Kennedy forum supports a proposal recently introduced in the Illinois General Assembly, HB68, HAM1 – Amendments to the Heroin Crisis Act (Lang). We believe this bill improves enforcement of existing mental health and addiction parity laws.
Provides clarity and specificity
- Updates unclear definitions in current law
- Clarifies state agencies’ jurisdictions and application of existing parity law to individual and marketplace plans (already required under federal law)
- Clarifies that all MAT (Medication Assisted Treatment) medical necessity determinations, just as other substance use disorder treatments, must comply with the American Society of Addiction Medicine Practice Guidelines
Requires transparency
- Specifies information that plans must report to ensure compliance
- Specifies information to be included in annual report to the General Assembly
Ensures accountability
- Specifies how the respective agencies are expected to enforce the law
- Provides a mechanism by which IDOI and DHFS may request formal opinion of the Attorney General on the interpretation, implementation, or enforcement of the law
- Allows consumers and providers to pursue causes of action against the plans for mental health and substance use disorder (MH/SUD) parity violations
Why HB68 is Needed
Inadequate Networks, High Out-of-Pocket Costs
- In-network providers are harder to find and patient out-of-pocket costs are often higher for mental health services, according to NAMI data
More Frequent Denials
- Claims for MH/SUD are more frequently denied than medical/surgical claims, according the federal Mental Health and Substance Use Disorder Parity Task Force
- 29{c48ccdf3c73afb47c94c61fa7aae86e62bfbb2e57db984400d0c5994c9d92c5c} of respondents in a recent NAMI survey reported having mental health services denied, compared to only 14{c48ccdf3c73afb47c94c61fa7aae86e62bfbb2e57db984400d0c5994c9d92c5c} of respondents who had been denied for general medical care
Consumers Kept in the Dark
- Without transparency, consumers often cannot know if they are being discriminated against
- “Non-Quantitative Treatment Limitations” are particularly problematic because they are currently difficult to track and often applied inequitably
Enforcement Makes a Difference
- Nearly half of previously rejected MH/SUD claims were overturned on appeal after New York increased enforcement of parity laws Based on Expert Recommendations
- Provisions are consistent with SAMHSA findings on State best practices in parity implementation and with recommendations from a MH/SUD working group of the Department of Insurance
Who Supports HB68
American Foundation for Suicide Prevention
Community Behavioral Healthcare Association
Depression & Bipolar Support Alliance
Family Guidance Centers
Gateway Foundation
Health & Medicine Policy Research Group
IARF
Illinois Association for Behavioral Health
Illinois Collaboration on Youth
Illinois Health and Hospital Association
Illinois Psychiatric Society
Illinois Psychological Association
Illinois State Medical Society
MADO Healthcare<
NAMI Barrington Are
NAMI Chicago
NAMI Illinois
Rosecrance
Sargent Shriver National Center on Poverty Law
TheKennedy Forum
Thresholds
Additional resources
- Parity Track https://www.paritytrack.org/
- Federal Task Force Report https://www.hhs.gov/about/agencies/advisory-committees/parity/
- Parity Complaint Registry and Appeal Resource http://parityregistry.org
- NAMI Parity Survey http://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/Mental-Health-Parity-Network-Adequacy-Findings-/Mental_Health_Parity2016.pdf
Contact
To sign on as a supporter, or for more informaion, contacft Kelly O’Brien or David Lloyd with The Kennedy Forum kelly@thekennedyforum.org; david@thekennedyforum.org
Download the Testimony and Fact Sheets Here:
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