The Illinois General Assembly advanced two measures pushed by the state's behavioral health reform advocates that aim to expand insurance coverage available to people seeking care.
Both bills passed the House on April 19 and are now before the Senate, but supporters say access to support systems for people suffering from mental health and substance abuse issues remains high. The aim is to address these inequalities. Post-pandemic rates of coronavirus disease (COVID-19).
A bill introduced by state Rep. Lindsey Lapointe, a former social worker who represents part of Chicago's Northwest Side and chairs the House Mental Health and Addictions Committee, would allow more behavioral health providers to become commercially available. The purpose is to encourage people to join the insurance network. , reducing costs for some who seek services.
The bill's language was developed in collaboration with Illinois-based mental health organizations, including the Chicago chapter of the National Alliance on Mental Illness and Threshold, a nonprofit social services organization that treats severe mental health and substance use disorders. .
Although the majority of Thresholds' customers do not have the type of insurance the bill would regulate, Heather O'Donnell, the agency's senior vice president for public policy and advocacy, said it does prevent people from getting to a certain point. He said this effort remains important because of the potential. of crisis.
“It takes about 10 years, a solid 10 years, for someone with a severe mental illness to find the appropriate treatment and support to stabilize their condition,” O'Donnell said in an interview. “Imagine a day when it won't take 10 years, but a month or two. That's what we should focus on. And access providers who can help spot the signs of serious mental illness.” People who can, that’s what we’re aiming for.”
Another bill, introduced by state Rep. Mary Gill of Chicago, would require municipalities in the state to cover couples and family therapy in insurance plans for police officers and firefighters and their spouses. Thing.
Lapointe's bill aims to ensure that mental health and substance use disorder benefits are as favorable as medical and surgical benefits under group health plans and insurance.
According to a report by the nonprofit Research Triangle Institute based on data collected from 2019 to 2021, reimbursement levels within networks across the country are lower than that of behavioral health providers such as psychiatrists and psychologists compared to physicians. This was approximately 22% lower than for healthcare providers such as assistants.
As a result, fewer clinicians will choose to accept insurance, leaving fewer service options for patients who can't afford copays, Lapointe said.
“Basically, they're like…I'm not going to be in the insurance network. If people want to come see me, they can pay out of their pocket,” Lapointe said. .
Patients seeking behavioral health care in the U.S. are out of network 3.5 times more often than patients seeking medical or surgical treatment, according to the RTI report.
Lapointe said state intervention is needed to correct discriminatory insurance practices and make behavioral health more widely available. Her bill would establish a minimum percentage of reimbursement for behavioral health professionals for care covered by state-regulated commercial insurance plans, which make up about 40 percent of all commercial insurance plans in Illinois.
The bill would require reimbursement rates to be at least 141% of the “Medicare rate for mental health or substance use disorder services provided.” That number is comparable to reimbursement rates for physical health services, Lapointe said.
“We're talking about a 40% to 50% increase in reimbursement rates, which is a pretty big incentive for providers to actually join the network,” she said.
Although the minimum reimbursement rate requirement is the provision likely to have the most impact, other aspects of the bill would also address other issues that impact the availability of behavioral health services, Lapointe said.
The bill would require insurance companies to cover the work of behavioral health providers who are in the process of becoming licensed and trained under the direct supervision of a licensed professional. . This would rapidly expand options for people seeking insurance-covered support.
After consulting with his medical practitioner and insurance company, LaPointe added coverage for the 60-minute therapy session and multiple behavioral health services received on the same day to his billing requirements.
“This happens a lot. People go to a health care provider, have a therapy session, and then sometimes see a psychiatrist for 15 minutes,” Lapointe said. “And the insurance company thinks, 'Oh, no, he's the only one of these we're paying for,' because there's no law that says the insurance company can't pay. .”
He said therapists who accept insurance are currently encouraged to limit session length to 45 minutes, as networks often require additional documentation from therapists who try to bill by the hour. Stated. “They were driven to give less to people,” Lapointe said.
Insurance industry lobbyists continue to voice their opposition to reimbursement floors, but do not take issue with other legislative changes.
In an interview, Kathryn Morthland, director of policy and advocacy for the Illinois Life and Health Insurance Council, praised the bill's sponsors for taking insurance companies' concerns into account.
But she argued that mandating a minimum reimbursement rate could remove incentives for behavioral health workers who are already paid above that level. Ms. Morthland said the interest rate requirement “could be a cap rather than a floor,” and she said negotiations on the provision would continue until the bill is introduced in the Senate.
Lapointe said most of the burden of implementing the requirements would be borne by insurance companies, but the state would need about $11 million for the state employee health insurance plan. He said cost should not be a major barrier “in the overall plan” but was likely to be discussed further in the future.
“We've been way behind when it comes to behavioral health and have focused on other things to keep our heads above water. This is the next natural step,” Lapointe said. Told.
The narrower bill proposed by Gill would help close gaps in insurance coverage for first responders in some Illinois municipalities, including the city of Chicago, that some mental health experts say It is the purpose.
Kathleen McShane, owner of Begin Within Therapy in Chicago, says many of her clients who have insurance plans through their jobs as police officers or firefighters lack coverage for couples and family therapy. Told.
McShane said in an interview that other insurance plans “very rarely deny service.” “So it was of particular concern that it was unique to this population.”
Behavioral health conditions such as depression and post-traumatic stress disorder affect first responders at a rate 10% higher than the general population, according to a report from the U.S. Substance Abuse and Mental Health Services Administration. . Firefighters and police officers also have a higher risk of suicide than the general public.
These issues often affect first responders' home lives and spouses, McShane said.
“The stress is even greater because of the nature of their work. There's stress from the strain of shift work,” she said. “We do see higher rates of substance abuse. There may be higher rates of domestic violence. It's important to have support in place when these facts are known.”
The bill, introduced by Gill, a Democrat who represents the Southwest Side and parts of the southwestern suburbs, would cover state, county and city government insurance plans for police officers, firefighters, and their spouses and partners. The content requires coverage of therapy. Without insurance coverage, a single appointment can cost him more than $200, a big barrier for many people, McShane said.
The bill passed the House without a vote and has support from groups including the Illinois Counseling Association, the Illinois Sheriffs Association and the Illinois Firefighters Association.
Eric Steinmetz, vice president of the Chicago Fire Union, is pushing for family and couples therapy for city employees and believes cost is the main reason more first responders don't seek treatment. He said that
“This is one of those things that will save you money in the long run, if people can get treatment ahead of time,” Steinmetz said in an interview. “This saves some people from missing work and having their lives ruined because of it.”
