06/12/2020

OPPA testifies in support of HB 443 - mental health parity

OPPA past president, Bill Resch, DO provided testimony on behalf of OPPA this week to members of the House Health Committee on HB 443, which would bring Ohio's mental health parity laws in compliance with the Federal Parity Law, the Mental Health Parity and Addiction Equity Act of 2008. MHPAEA states that health insurers must cover mental health illnesses and substance use disorder no more restrictively than physical illnesses of the body.

Earlier this General Assembly, OPPA testified in support of Senate Bill 254 and its companion bill, House Bill 443, will give Ohioans expanded access to mental health and addiction treatment. There are additional reporting requirements in the legislation, giving regulators powerful means by which to hold health plans and state officials accountable and enforce parity requirements. HB 443/SB 254 will also facilitate easier access to medically-necessary substance use disorder medications for Ohioans in need.

Dr. Resch stated in his testimony, we see many areas in which patients with mental illness and substance use disorders face insurance limitations that people with physical health diagnoses do not. An important example of this is the practice of quantitative limits on physician office visits and hospital stays. The plans that many patients have in Ohio, even when they have chosen plans specifically because they afford mental health benefits, have arbitrary rules stating how many physician visits they will cover for treatment of a mental health condition. Because of this, an outpatient physician who sees a patient frequently because of illness exacerbation may be denied payment for a claim and told that they have already seen the patient for the allowable number of times that year.  An inpatient physician who is treating a patient who was doing poorly enough to be hospitalized for their mental illness may be denied payment for hospital days subsequent to an arbitrary cut off number.  These denied claims, as well as prior authorization requirements and other administrative burdens, are reimbursed for behavioral health specialists nearly 25% less than for primary care.  This all results in poor care for patients, and frequently, in lack of access to care as more and more physicians opt out of insurance panels because they will not practice under limitations that they know will result in substandard care.

Ultimately, if individuals are not able to access the mental health and substance use disorder coverage they (or their employer) have paid for we begin to see more and more individuals experiencing untreated mental illness, which can result in job loss, and potentially becoming a part of the public mental health system, which increases the state’s Medicaid costs. Or, worse, they could become one of a growing number of individuals who die by suicide in our state.

The OPPA will continue to be a strong advocate for mental health parity as the companion bills move through the legislative process.