Legislators in the last legislative session increased state oversight for a 2008 federal law requiring insurance companies to provide behavioral health benefits on par with physical health.
But what if consumers are trying to access these benefits and are unable to book timely appointments with therapists in our network or find a substance abuse treatment provider in their area?
Advocates argue that state legislators should do more to hold insurance companies accountable when the availability of behavioral health services isn’t what it seems. care system.
A bill designed to address this problem (known as Network Adequacy) was one of several bills introduced during this legislative session that were intended to build on the high-profile bipartisan bill. It may be nothing more than passed last year.
Published by the Influential Behavioral Health Reform and Innovation Commission new slate This includes demanding “strong” criteria for network adequacy.
The conclusions of last year’s committee helped shape broader behavioral health. bill advocated by The late Speaker of the House David Ralston died suddenly in November.
There are signs that Ralston’s absence hasn’t slowed him down. Mr. Ralston had been hailed as one of the movement’s strongest defenders, but the leadership of both houses had changed.
Kevin Tanner, chairman of the committee and former Republican congressman, said: lead now State Office of Behavioral Health and Developmental Disabilities. Tanner often refers to this as “his decade of mental health reform.”
In an interview Friday, Tanner said it was no coincidence that Gov. Brian Kemp appointed the head of a reform-minded commission that heads state agencies.
“[The governor]wants this system to work for Georgians,” he said. “And when he asked me to take on this role, he told me that’s why he put me there.
Ralston’s widow, Sherry Ralston, is also in the runoff to replace the Blue Ridge Republican as a state legislator. The speaker 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 hailed as a landmark piece of legislation, but also as the start of a long road to improving access to behavioral health services after the COVID-19 pandemic has highlighted a heightened need. was widely seen.
That work is set to continue this session despite the upheaval under the Gold Dome.
“The members of the subcommittee and committee have been working hard since Sine Die and are pleased to be able to propose important new reform proposals. We’re excited, we still have a lot of work to do,” Decatur Democratic Rep. Mary Margaret Oliver, who co-sponsored last year’s bill, said Friday.
The new recommendations address behavioral health workforce shortages, facilitate data collection and information sharing across state agencies, and make more changes to improve the capacity of Georgia’s crisis services system. We are moving legislators towards
“A lot of it goes back into the workforce,” says Tanner. “Every problem we identified, every problem we talked about, almost without exception, can only be addressed by addressing the workforce issue.”
The Commission seeks, among other things, to target staffing shortages by increasing Medicaid reimbursement rates for the behavioral health workforce and creating new loan forgiveness and repayment programs for mental health professionals already in the workforce. Recommended.
And the commission concluded that in order to ensure that people in Georgia have access to existing behavioral health services, the state needs to implement stricter standards for network adequacy.
Marietta Republican State Senator Kay Kirkpatrick said it was “intended to ensure that consumers have access to the care they pay for.”
“This is an epidemic and it’s time to treat it as such”
Advocates say they are optimistic that behavioral health will remain a legislative priority for lawmakers this year.
Kim Jones, Executive Director of NAMI Georgia, a member of the Commission and leader of a coalition of advocacy groups, said:
“Every legislator out there knows someone in their own community, if not their own family, who are struggling with mental health and can’t find care.” They know what we can do, so I feel the momentum is still there.”
Jeff Breedlove, head of communications and policy for the Georgia Recovery Council and co-leader of a broad coalition of advocacy groups, points to disturbing data from the Centers for Disease Control and Prevention last fall. Shortening life expectancy in America.
“My message to governors, presidents, mayors and the General Assembly: This is an epidemic and it’s time to treat it as such,” said Breedlove. We need to get serious about the fact that these health problems, especially addictions, are literally impacting our lifespans.”
According to the 2023 rankings released by Mental Health America, Georgia still ranks near the bottom for access to mental health care services and professionals.
“People don’t know what (parity) is”
The bill that passed this legislative session will become law because elements of last year’s sweeping bill are still being realized.
That’s part of the reason parity violation complaints from Georgians haven’t spiked so far.
As of late December, there were only two complaints from consumers with private insurance, according to information from the John King Insurance Commission.
This came as no surprise to supporters who pushed hard for legislation last year.
“A big part of it is that no one in Georgia knows where to go if their birth count is violated,” said Roland Boehm, director of the Georgia chapter of the American Foundation for Suicide Prevention. rice field. “People don’t know what they are entitled to and where to complain if they don’t get it.”
King’s office is developing a new system for consumer complaints and plans to begin accepting reports of suspected parity violations by June of this year. can claim here.
Private insurers will also have to submit more parity information to the insurance commissioner’s office starting this month, and Medicaid care governing bodies will have to do the same with state community health departments.
NAMI Georgia’s Jones said the process is more likely to identify potential violations than leaving consumers to report problems.
“Most people have to tell you what equality means,” she said. “I don’t think we’ve seen a lot of complaints because the public isn’t aware of what it is.”
Parity violations come in many forms, such as paying higher costs for prescription drugs for mental health care than for physical care, or limiting visits to mental health services to fewer than other types of health care. There is a possibility.
Jones said consumers should be aware of extra charges on their bills and ask insurance companies to confirm in writing whether the charges are comparable to other physical and surgical charges. said I need to.
If someone suspects a breach, the first step is to raise the issue with the insurance company. If that doesn’t work, you can file a complaint with your state’s Department of Health, Safety and Fire, although large self-funded corporate plans are regulated by the U.S. Department of Labor. and PeachCare.
“If they can’t find a provider in their area, go there. “But what we’re trying to do is measure it at the state level, so people are going to have him make one-off calls and say, ‘Wait a minute, we don’t have a network.’ No need to.”
“One person cannot get insurance companies to do it. The state can do it, and there are some consequences for not doing it.”
