In the months since Dec. 14, gun owners and 2nd Amendment supporters have complained that lawmakers were focusing too much on guns instead of addressing the mental health issues that contributed to the massacre in Newtown.
“Contact your legislators and tell them to focus on mental health issues,” a radio ad by the Connecticut Citizens Defense League says.
As it turns out, legislators did just that. According to a pair of health care advocates and a lobbyist for the private insurance industry — people who most often find themselves on opposite ends of the negotiating table — lawmakers managed to come up with “strong” mental health provisions in the bipartisan legislative package, provisions that they expect will have a lasting impact on access to mental health services.
It is worth noting that the legislature had a head start on the process. Even before the gunman walked into Sandy Hook School on Dec. 14 and killed 20 children and six educators, lawmakers and their staffers were working on improving access to mental health and behavioral health services. The horrific events in Newtown just acted as a catalyst to bring advocates and the industry together to resolve the problem.
Several public hearings on the issue demonstrated what advocates already knew — Connecticut residents still face significant barriers to treatment for mental health and substance use disorders. Despite federal and state mental health parity laws, it’s an area of the health care system where having private insurance doesn’t necessarily mean access to services.
The bill the General Assembly will debate today would require mental health and substance abuse services to be considered “urgent care” and also shortens the review time for service requests from 72 hours to 24 hours.
The legislation also requires:
—insurance companies to inform consumers that they have the right to appeal a denial of care;
—the Insurance Department to evaluate and report on compliance with mental health parity laws, and;
—the health professional reviewing an insurance claim to have similar qualifications to the medical professional prescribing it.
State Healthcare Advocate Victoria Veltri called the proposal a “very strong and bold piece of legislation.”
The bill includes many more protections for consumers than ever existed before in the state, she said.
In addition, the legislation requires insurers to tell consumers how they came up with any decision to deny services and creates a more “standardized criteria for determining what treatment qualifies as medically necessary,” Veltri said.
Basically, it “adds a level of transparency that never existed before,” she said.
Daniela Giordano, public policy director for the National Alliance on Mental Illness (NAMI), agreed.
“It will increase access for people with private insurance,” Giordano said. “It will improve response time and you will really understand, if they do deny care, what their decision is based upon.”
The Insurance Department would be tasked with evaluating compliance with the new provisions of the law to make sure various mental illnesses and behavioral health issues are treated the same way as any medical condition.
The legislation also would create a task force with a special focus on 16- to 25-year-olds to study Connecticut’s mental health system. It’s unclear exactly what the composition of the task force will look like or how many members it will have, but Giordano is hoping it includes consumers directly impacted by challenges with mental health issues.
The legislation also calls for the implementation of recommendations from a Program Review and Investigation Committee report on “Access to Substance Use Treatment for Insured Youth.”
According to an insurance industry lobbyist, insurers have agreed to the proposal.
The basic idea is “let’s make sure the process for getting payment doesn’t constitute an impediment for getting the care,” Keith Stover, a lobbyist for the Connecticut Association of Health Plans, said Tuesday.
He said both advocates and insurers sat down in earnest to try and come up with a solution and he believes the legislation strikes the appropriate balance. It gives consumers faster information and better information about how decisions are being made.
“This is, I think, a piece of landmark legislation everyone will look back on with pride and real satisfaction that we have accomplished something,” Stover added.
Stover and Veltri both said the process of helping draft the public policies included in the bill was cooperative and pleasant.
In the end, Stover said he’s hopeful that the will be one of the few pieces of legislation he can look back on when he retires and know he accomplished something lasting and meaningful.
The proposal won’t cover all privately insured plans in the state, but that’s not unusual. State laws don’t apply to self-insured plans usually offered by large employers.
The legislation also addresses some issues in the public healthcare system used by low-income individuals. It expands some services in the Department of Mental Health and Addiction Services, adds case management for individuals involved in the Probate Court system, and establishes a program that provides support to pediatricians to help them intervene with children who have mental health conditions.