In the latest legislative session of the state’s oversight, lawmakers stepped up a 2008 federal law that requires insurance companies to offer behavioral health benefits commensurate with physical health.
But what happens when consumers try to access these benefits and can’t book a timely appointment with an in-network therapist or find a substance abuse treatment provider in their area?
Advocates make a case that state lawmakers should do more to hold insurance companies to account when the availability of behavioral health services is not what it seems, and say it should be one of the next steps taken in the multiyear effort to lift Georgia’s default. care system.
A bill designed to address this problem — known as network sufficiency — is likely just one of several measures introduced in this legislative session that aim to build on a high-profile, bipartisan measure. Last year passed.
The Commission on Behavioral Health Innovation and Reform issued an influence new listing From Thursday’s recommendations, including a call for “robust” standards for network suitability.
In the past year, the panel’s conclusions have helped shape comprehensive behavioral health Sponsored Bill The late Speaker of the House David Ralston who He died unexpectedly In November.
There are signs that the momentum has not slowed in the absence of Ralston – hailed as one of the cause’s strongest champions – and with both chambers undergoing a change in leadership.
Committee Chairman, former Republican Representative Kevin Tanner, lead now Department of Behavioral Health and Developmental Disabilities. Tanner often calls this the “decade of mental health reform.”
It’s no coincidence, Tanner said in an interview Friday, that Gov. Brian Kemp appointed the chair of the reform-oriented commission to lead the state agency.
“(The ruler) wants to make the system work for the Georgians,” he said. “And he told me when he asked me for the role, that was the reason he put me there — he wanted me to go forward and improve the system and make it the best in the country.”
Ralston’s widow, Sherri Ralston, is also in the runoff to replace the Blue Ridge Republican as state representative. The spokesperson said it was his wife who challenged him to use his position to improve access to mental health treatment in Georgia.
“There’s still a lot to do.”
Last year’s bill was announced as landmark legislation, but it’s also widely seen as the beginning of a long road toward improving access to behavioral healthcare services after the COVID-19 pandemic highlighted a growing need.
This work is scheduled to continue in this session despite the turmoil under the Golden Dome.
The subcommittees and committee members have worked hard since Sine Die and are happy to put forward important new reform proposals. Rep. Mary Margaret Oliver, the Decatur Democrat who co-sponsored the bill last year, said Friday that many advocacy groups have been involved in the process and is excited about more progress — there’s still a lot to do.
The new recommendations urge lawmakers to make further changes aimed at addressing a behavioral health workforce shortage, encouraging data collection and information sharing across state agencies, increasing the capacity of Georgia’s crisis services system, and more.
“A lot of that comes down to the workforce,” Tanner said. “All the problems we’ve identified, all the problems we’ve talked about, most of them without exception, we can’t address if we don’t address the workforce issue.”
The committee recommends targeting staffing shortages by increasing Medicaid reimbursement rates for the behavioral health workforce and creating a new loan forgiveness and reimbursement program for mental health professionals already in the workforce, among other things.
The committee concluded that the state must implement stricter network adequacy standards to ensure that Georgians can access existing behavioral health services.
“The idea is to make sure consumers get the care they pay for their premium,” said Republican Sen. Marietta Kay Kirkpatrick, who says she plans to introduce a bill to deal with network adequacy this year.
“This is an epidemic and it is time to treat it as such.”
Advocates say they are optimistic that behavioral health will remain a legislative priority for lawmakers this year.
“Speaker Ralston made it happen for everyone, and that’s what he said: Mental health is everyone’s problem,” said Kim Jones, executive director of NAMI Georgia, a panelist and leader of a coalition of advocacy groups.
“Every legislator knows someone in their community, and if they’re not in their family, they’re mentally ill and they can’t find care,” she said. “So, I still feel like that momentum is going to be there because they realize what we can do.”
Jeff Breedlove, president of communications and policy at the Georgia Council on Recovery who also co-leads the broad coalition of advocacy organizations, points to troubling data released last fall from the Centers for Disease Control and Prevention that showed drug overdoses as a contributing factor to the average default. Life expectancy in America.
“My message to the governor, the president, the mayor, and the General Assembly: This is a pandemic, and it’s time to treat it as such,” Breedlove said. “We need to mobilize, organize, and get serious about the fact that behavioral health issues, especially addiction, are actually affecting our life expectancy.”
Georgia also continues to rank last for access to mental health care services and professionals, according to the 2023 rankings from Mental Health America.
“The public doesn’t know what (valence) is”
Any bills passed in this legislative session will come while elements of last year’s sweeping bill are still very much alive.
This is partly why there has been no jump in complaints of equality violation from Georgians.
As of late December, only two complaints had been received from consumers with private insurance in the past year, according to information from the Office of Insurance Commissioner John King.
This came as no surprise to advocates who lobbied hard for the legislation last year.
“A big part of it is that no one in Georgia knows where to go if they have a parity violation,” said Rowland P., who serves on the board of directors for the Georgia chapter of the American Foundation for Suicide Prevention. “People don’t know what they are entitled to and where to complain when they don’t get it.”
King’s Office is developing a new consumer complaints system, which is set to begin accepting reports of suspected parity violations by June of this year. Meanwhile, consumers can continue to file complaints online here.
Private insurers must also begin submitting more equivalence information to the Insurance Commissioner’s Office starting this month, and Medicare administration organizations must do the same with the state Department of Community Health.
This process is more likely to identify potential violations than relying on consumers to report problems, said Jones of NAMI Georgia.
“Most people,” she said, “we have to tell them what equivalence is.” “I think we haven’t seen a lot of complaints because the public is not aware of what they are.”
Violation of parity can come in many forms, such as paying higher costs for medications prescribed for mental health treatment than for physical therapy or limiting the number of visits to mental health services compared to other types of health care.
Jones said consumers should be vigilant when they see additional costs on the bill and ask their insurance company for written confirmation whether the fee is equal to other physical and surgical costs.
If someone suspects a violation, the first step is to raise the issue with the insurance provider. If that goes nowhere, a complaint can be filed with the insurance office and state fire safety commissioner for private insurance plans, although large, self-financed corporate plans are regulated by the U.S. Department of Labor. The state Department of Community Health oversees Medicaid and PeachCare for Children.
“If they can’t find a provider in their area, there you go. That’s a violation of network adequacy right there,” Jones said. “But what we’re trying to do is measure it statewide, so people don’t have to make a one-time call and say, ‘Wait. Moment, no network.”
One person will not be able to get an insurance company to do this. The state can, and there are some consequences for not doing so.”