Committees dealing with mental health and addiction met in both the Illinois House and Senate Friday to discuss a new crisis born from the COVID pandemic.
“We're fully into what I consider to be the second pandemic, which is mental health and addiction, and we have so much work to do,” Rep. Deb Conroy, D-Villa Park, said during a meeting of the House Mental Health and Addiction Committee, which she chairs.
According to Conroy, the isolation and loss of normalcy caused by the pandemic has exacerbated the prevalence of drug abuse and mental illness, which Conroy says are the same problem. It’s also caused distress in populations much younger than usual with the closure of schools.
“When I talk to pediatricians, they're telling me they're not seeing kids for physical health issues because they're not getting sick, there's no flu, there's no cold because they're wearing masks, but they're seeing children every single day for mental health issues,” she said.
The committee took no action Friday, but placed several bills on its schedule to be heard March 19.
Following the House committee, the Senate held a joint hearing between the Senate Behavioral and Mental Health Committee and the House Mental Health and Addiction Committee to discuss actions the General Assembly could take to remove obstacles to mental health care in Illinois, and expand access for those suffering.
In order to address those issues, a top priority for both of the committees is to further strengthen Mental Health Paritylegislation to ensure that mental health receives the same protections under law as other health issues when it comes to insurance coverage.
The law was enacted in 2015 and included provisions to extend and clarify coverage, educate consumers about their rights, require certain minimum treatment benefits and improve enforcement of the law, according to Get Covered Illinois.
Mental Health Parity has been revisited nearly every legislative session since its initial passage.
In 2019, the General Assembly passed an update to the parity law to create a working group to develop a reporting template for health insurers and Medicaid health plans to demonstrate parity compliance.
David Applegate, director of state policy at the Kennedy Forum Illinois, was part of that working group.
“There's nothing about what is currently taking place in Illinois with the workgroup that ensures medical necessity determinations are consistent with generally accepted standards of care,” Applegate said. “Nothing about the current process looks at what is clinical best practice or ensuring that the criteria itself is consistent with what is based on evidence and science. That is why we need to take action.”
Generally accepted standards of care are defined by the National Council for Behavioral Health as level-of-care criteria or guidelines by which mental health and substance use service providers, as well as insurers, determine the level of care an individual should receive for behavioral health treatment.
Even with parity laws in place, witnesses say there are still cases where insurance companies deviate from accepted standards of care, denying mental health care and restricting access to relevant services.
This is the basis of a class action lawsuit, Whit v. United Behavioral Health, co-led by Meiram Bendat, psychotherapist, attorney and founder of Psych-Appeal. Bendat testified before the joint committee Friday and presented some findings from the lawsuit, which involves Illinois residents.
Despite the Affordable Care Act’s guarantee of access to essential health benefits, including mental health treatment, Bendat said many states, including Illinois, lack legislation that defines “medical necessity,” a distinct phrase in the law, for commercial health plans.
“Consequently, insurers are generally free to undermine the ACA promise of essential health benefits by creating self-serving definitions of medical necessity that may not hinge on treatment being consistent with generally accepted standards of care, but rather on proprietary non-transparent standards that fail to accommodate the mental health needs of chronically and or pervasively ill patients,” Bendat said.
Multiple committee members and witnesses were expressed concern that insurers could use flawed definitions to deny care. One solution to this problem, Bendat suggested, could be incorporating a common language for insurers.
“By promoting a uniform standard for determining medical necessity, you're ensuring that we have equal access at least on a coverage level,” Bendat said. “But from the standpoint of whether we're going to be authorized for treatment, why shouldn't we assume that whoever we have as our carrier is going to make a decision in the same way as another carrier, based on prevailing standards in the community.”
Defining medical necessity, as well as identifying and addressing barriers in access to care, especially for low-income and minority communities, is a goal lawmakers in both chambers said they will work to rectify in the 102nd General Assembly.
Another pressing issue is the state’s ongoing shortage of psychiatrists, which makes access to care even more difficult, especially in rural and downstate regions of Illinois.
“Part of why we don't have the physicians and the access is because of our reimbursement rates because we don't pay them enough, so we don't have enough psychiatrists,” Conroy said. “The number of psychiatrists is pitiful in the state and in the country. So this bill is necessary because we have to take these barriers away.”
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