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- A new bill would help frustrated mental health patients.
Yet, a December 2017 report from Milliman Research found that Coloradans go out of network for mental health care around seven times as often as they do for physical care, and that mental health providers are reimbursed at rates about 40 percent lower than other health care providers.
Andrew Romanoff, president and CEO of Mental Health Colorado, says those numbers tell a story: Many people experiencing mental health problems are struggling to find a provider, and fewer providers are likely to be available in the future because the system doesn’t offer such workers competitive wages. His organization is aware that many people wait far longer than seven days for care.
“If you need mental health care... chances are you probably don’t have all the time or money in the world to fight an insurance company and you shouldn’t have to,” he says.
That’s the idea behind House Bill 1357, which would create an ombudsman to help patients get services, and require the state to better monitor insurance companies’ mental health care services.
And such a bill would be key in El Paso County, where the 2017 Colorado Health Access Survey found that 12.1 percent of residents experienced eight or more days of poor mental health in the previous 30-day period (statewide the number stood at 11.8 percent).
The bill, which has been introduced, has bipartisan sponsorship from Sen. Bob Gardner, R-Colorado Springs; Rep. Dafna Michaelson Jenet, D-Commerce City; and Sen. Angela Williams, D-Denver. Gardner says he expects the bill to help people navigate services. “It’s that simple,” he says.
The bill’s fiscal note says it will require a $130,896 appropriation to the Department of Human Services and the Department of Regulatory Agencies, and that it will cost $147,329 in its first year and $194,450 in its second year.
It requires the governor to designate an ombudsman by Jan. 1, 2019, and for that person to field complaints and concerns from consumers, as well as report violations of laws by insurance companies.
“The ombuds-person shall serve as a neutral party to help consumers, including consumers who are uninsured or have public or private health benefit coverage, including coverage that is not subject to state regulation, and behavioral health care providers, acting on their own behalf, on behalf of a consumer with the consumer’s written permission, or on behalf of a group of behavioral health care providers, navigate and resolve issues related to consumer access to behavioral health care, including care for mental health conditions and substance use disorders,” the bill states.
Romanoff says that a lot of insurance companies argue that there simply aren’t enough providers, but, he says, if that’s the case, then insurance companies should increase reimbursement rates to attract more. On the flip side, he’s heard of insurance companies claiming they don’t need more providers, even as their patients complain that they can’t get an appointment.
Having an ombudsman, Romanoff says, means consumers would have a helper on their side when they’re unable to schedule an appointment or locate a provider. And he argues that the system should actually help the bottom line for insurance companies.
“The evidence is pretty clear that mental illness is treatable and early intervention is the key,” he says. “So you can try to ignore mental illness but you just pay more.”
The other half of the bill is less likely to appeal to insurance companies, however. It requires insurance carriers to submit an annual report to the insurance commissioner intended to show how the companies treat mental versus physical health care and whether they are providing adequate mental health care. The commissioner is then charged with presenting a report on those reports to the Legislature that also includes any corrective actions taken against companies to ensure compliance. The report will be made available to the public.
Asked for comment, Kaiser Permanente spokesperson Meredith Jones emailed the following statement, “We are aware of House Bill 1357 and are actively monitoring and working to understand what it could mean for Kaiser Permanente, our members, staff and physicians.”
Kaiser isn’t alone in holding back on taking a position. AspenPointe, the largest mental health provider in the Colorado Springs area, likewise said it wouldn’t take a position on the bill.
But other major players are offering support, including the Colorado Behavioral Healthcare Council, which represents major behavioral health care entities in the state, including AspenPointe.
Other supporters include the Colorado Psychiatric Society, Colorado Psychological Association, the Colorado Mental Wellness Network, the National Association of Social Workers – Colorado Chapter, Rocky Mountain Crisis Partners, NAMI Colorado, and the Colorado Hospital Association. Joshua Ewing, the Hospital Association’s manager of regulatory affairs, says via email, “The Association believes this bill will benefit both patients and policy-makers. Patients will have the advantage of additional assistance while navigating the sometimes complex process of getting access to care and utilizing their coverage and policy-makers will have the benefit of additional data with which to better understand behavioral health needs.”
House Bill 1357 is one of a group of bills that Mental Health Colorado is lobbying for in this session. Another, which may soon be introduced, would allow police to temporarily remove weapons from a home with a court order if an occupant is found to be a danger to themselves or others. One other that is also expected to be introduced soon would provide transition treatment for those released from a 72-hour hold, which is issued when someone is deemed a threat to themselves or others.