Introducing House Bill 3046:
Improving Access to Behavioral Healthcare Through Parity
House Bill 3046 is a culmination of over a decade of effort on behalf of COPACT to improve access to mental health care in Oregon by reducing the unfair insurance practices that prevent our clients from receiving the treatment they need. Low reimbursement rates, random rate cuts, extra fees, denied claims, time consuming utilization reviews, unnecessary pre-authorizations – these are just a few of the abusive practices that have driven many counselors and therapists away from insurance panels. Oregonians must wait months, in some cases, to meet with a mental health provider in a community agency, while counselors and therapists working in hospitals are pressured to terminate services prematurely, simply because a client has met their coverage limit. The majority of insurance providers in Oregon lack an adequate number of mental health providers to meet the needs of their consumers. As a result, many clients must pay out of pocket for mental health treatment, despite having full coverage. Can you imagine having to pay out of pocket for a medical procedure because you couldn’t find a doctor that accepted your insurance?
Improving Access to Care Through Parity:
Mental health parity laws were first established in 1996, then updated and expanded with the implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, and expanded further in 2010 under the Affordable Care Act. Oregon’s state parity law was implemented in 2007 and has been touted as one of the most “comprehensive,” yet many insurers in Oregon continue to offer limited mental health services when compared to physical health services.
As it stands now, parity compliance is almost exclusively dependent on an individual making a complaint. In other words, our clients must have a strong enough understanding of Oregon’s parity laws in order to know that their rights have been violated, then they must know how to file an official complaint with the Department of Consumer and Business Services (DCBS). Unfortunately, few Oregonians (clients and providers alike) are aware of their rights when it comes to consumer insurance and the majority of parity violations in Oregon continue to go unreported. This fact, combined with a lack of state regulation, oversight or rule enforcement, results in insurance providers who are rarely held to account for parity compliance.
House Bill 3046 places parity compliance on the shoulders of the insurers, rather than clients, by establishing reporting requirements to regularly measure where disparities exist and ensuring that oversight and enforcement of our already existing parity law is actually taking place. This incentivizes commercial insurers and CCOs to provide appropriate reimbursement rates for counselors and therapists as a means to achieve a provider network that is equal to that of physical health networks. By addressing the market forces that lead to an increased number of providers, HB 3046 ensures that any individual or family seeking mental health treatment in Oregon, will have access to the full range of services, number of providers and urgency of care as those who seek treatment for physical health problems.
The Evolution of HB3046:
Beginning in 2017, COPACT worked alongside a coalition of behavioral health providers and advocates to help draft and pass Senate Bill 860, which required the Oregon legislature to assess the effectiveness of state parity laws. Unsurprisingly, the Senate Bill 860 Report, which was published in late summer, 2020, found that many insurers were not following the spirit, and in some cases the letter, of the Oregon State Parity Laws. In response to this report, COPACT immediately began forming a coalition of behavioral health care providers and consumer advocates with the goal of creating new legislation to increase access to mental health care by addressing Oregon’s parity problem.
With COPACT lobbyists Elizabeth Remley and Rachael Wiggins Emory in the lead, COPACT put together a broad coalition of support, including the National Alliance on Mental Illness, the Oregon Psychiatric Physicians Association, the Oregon Psychological Association, Oregon Independent Mental Health Professionals, the Association of Oregon Community Mental Health Programs, the Oregon Council for Behavioral Health, the American Psychiatric Association, the American Society of Addiction Medicine, and the Oregon Family Support Network. We also have committed support from the Oregon Medical Association, OHSU, Alliance 4 Kids, and the Association of Oregon Counties.
HB 3046 is an attempt to resolve several major problems in one bill (an “omnibus” bill) and we have received strong bipartisan support from Oregon legislators. Representative Rob Nosse of East Portland has been our champion in this effort. He has come to understand the complexities of insurance practices and he is an eloquent spokesperson for our effort. The coalition has been successful in narrowing the areas of disagreement posed by insurance carriers and CCOs, and will be finalizing technical amendments related to the bill’s implementation in the coming week. Additionally, coalition members will begin meeting with the Ways and Means Subcommittee on Human Services in hopes of having this bill be one of the first to move out of committee. It’s a Herculean effort on the part of COPACT and our lobbying team (if you ever wonder where your ORCA or OAMFT dues go, think of the funds we pay our lobbyists and how they have shepherded this critical legislation!)
We know that denying coverage to someone facing a life-threatening physical ailment is inhumane, yet we continue to encounter daily systemic barriers to vital behavioral health services. HB 3046 aims to modernize the definition of parity for mental health and substance use disorders to ensure equity with how health care systems cover benefits for physical health so that all Oregonians can have equal access to the mental health treatment they need, no matter their location or insurance provider.
Major Components of HB 3046:
Parity in Medicaid
- Clarifies legislative intent of HB 3091 from 2017 (which passed unanimously in both chambers.)
- Sets the expectation that following a behavioral health crisis, adults and children will receive a thorough behavioral health evaluation and the recommended treatments and supports necessary to transition to lower levels of care, including care coordination.
- Emphasizes that OHP members receive treatment and services that address the underlying conditions that drive crises.
Parity in Commercial Coverage
- Requires treatment and utilization management decisions be based on generally accepted standards of care specific to behavioral health conditions.
- Directs that treatment and utilization management decisions be based on treating underlying conditions, not only current acute symptoms.
- Ensures that decisions about duration of treatment are based on individual needs and the results of multidimensional assessments.
Parity Reporting & Network Adequacy
- Mirrors federal law that requires all commercial plans perform parity compliance analyses between medical/surgical and behavioral health;
- Applies standards to coordinated care organizations.
- Applies additional reporting requirements to ensure commercial carriers and CCOs are diligent in their efforts to achieve and maintain parity compliance.
- Adds network adequacy and reimbursement parity parameters to ensure that commercial and CCO plans offer robust provider panels that feature the varied expertise and evidence-based practices necessary to provide generally accepted standards of care.
The requirements in HB 3046 are in line with the 2019 ruling from the U.S. District Court of the Northern District of California in Wit v. United Behavioral Health, in relation to the Mental Health Parity and Addiction Equity Act of 2008. Similar legislation has been enacted in California and is pending in several other states. HB 3046 represents model legislation that is being proposed nationally.
For an updated section by section overview of the bill, click here: HB 3046 Section by Section
Please check out the COPACToregon.com webpage for further legislative updates.