Lawmakers are set to consider a plan to boost reimbursement rates and improve network adequacy for behavioral health services.
The legislative package from Sen. Karina Villa, D-West Chicago, and Rep. Lindsey LaPointe, D-Chicago, would set minimum reimbursement rates for in-network mental health and substance use disorder care at 141 percent of what Medicare pays for the same service — a figure stakeholders said would align it with other health services.
Other provisions would allow behavioral health providers to work toward licensure under the supervision of another fully licensed provider, require same-day coverage of behavioral health services and require a 60-day network contracting process for services.
LaPointe told Health News Illinois that the proposal aims to address inadequate behavioral health insurance networks by boosting rates and addressing other barriers that providers face in seeing patients.
“We’re at a moment where not only are we in a crisis, (but) stigma is down and people have a high willingness to seek treatment, which is a great thing,” she said. “The challenge becomes when they go to find that therapist, or they go to find that psychiatrist, it is so frustrating for people because they cannot find one who will take their insurance.”
Illinois Life and Health Insurance Council President Laura Minzer said they have worked with the bill sponsors for over a year on the proposal. While she said those have led to “important changes” to streamline the network contracting process and billing challenges, the industry remains opposed to any mandate for specific reimbursement rate requirements.
“The effect of requiring a specific reimbursement rate that would otherwise be negotiated in the contract between the two parties not only creates a concerning precedent, it will also increase premium costs for individuals, families and small employers,” Minzer said. “Additionally, individuals that have a high deductible health plan will likely feel the impact of this bill even more acutely since they are required to pay for health care services at a discounted rate negotiated by the health insurance plan before they meet their deductible.”
LaPointe said they will continue negotiating with the insurance sector on the plan, though she said they
“fundamentally believe” the reimbursement rate is key to the bill.
“The other key part of that is, data is very clear that when people get their behavioral health needs met, their physical health care insurance costs go down,” LaPointe said “So not only is this really important on a human level to get people to care that they desperately need, but all signs point to the fact that when people can take care of their behavioral health, it has a positive effect on how much their physical health care is costing.”
The hope, LaPointe said, is to begin moving the package through in the coming weeks.
Credit: Health News Illinois – Website
