Lawmakers seek to strengthen parity in Rhode Island

Rhode Island lawmakers are considering several proposals to strengthen mental healthcare and substance use disorder treatment.

Among budget items Gov. Gina M. Raimondo included in her proposal to the state General Assembly in mid-January, are:

• The creation of an acute mental health crisis center to help people navigate urgent mental health and substance use disorder crises and facilitate better connections to ongoing mental healthcare resources;
• The development of a benchmarking study under the leadership of the state Office of the Health Insurance Commissioner (OHIC), to benchmark under-investment in mental healthcare and provide recommendations about investments/policies for improving mental health provided by commercial insurers and Medicaid;
• Funds for a supported employment program that combines job training through a supported employment model with substance use disorder counseling; and
• The creation of a competitive pool of graduate medical education funds that support research and training related to substance abuse and mental health disorders.

“The Governor and her team are working with members of the legislature to craft legislation that will strengthen existing laws ensuring health insurance companies cover addiction and mental health treatment just like they cover diabetes or other chronic conditions,” said Catherine Rolfe, deputy press secretary for the governor’s office.

The legislation will be submitted sometime during the current legislative session, which typically runs from January-June, Rolfe said.

Health Insurance Commissioner Marie L. Ganim, Ph.D, said OHIC has been working hand-in-hand with the governor’s office and other state agencies on policies aimed at making sure the healthcare system is meeting Rhode Island’s needs. OHIC issued a report in November looking at the status of behavioral health parity.

“We have parity laws at the state level and the federal level, and over the years, there has been a progression of compliance, interpretation, and full implementation,” Ganim said.

When parity laws were first passed, there were different interpretations of, for example, what would constitute “comparable disease,” and the differences between qualitative and quantitative treatment limitations.

“It’s been an evolution,” Ganim said.

Ganim said insurance companies ultimately have the responsibility to comply with parity. “It’s really on their shoulders to do it,” she said.

Among complaints Ganim hears from constituents is that co-pays are high for some behavioral health services. Prior authorizations are also of concern.

Ganim said originally, prior authorizations were a way for insurance companies to either save money or ensure that the services that were being delivered really met evidence-based or medical necessity standards.

“Over time, some of that criteria maybe should have changed,” Ganim said. “We are working with insurers to make sure that happens.”

Ganim said her office asked insurers to report on how often they are using prior authorizations. “And we saw that many of the prior authorizations that are in place are for behavioral health services,” Ganim said. “We need to look more closely at that to see if it’s parity or not.”

Ganim is also looking into possible alternatives to prior authorizations to ensure a treatment is medically necessary.

She said insurers have been cooperative on this issue. “Our insurers want to do the right thing and they want to be in compliance.”