Illinois lawmakers are considering measures aimed at making mental health care more accessible

Illinois lawmakers have advanced two measures pushed by advocates for reforming the state’s behavioral health system to expand insurance coverage available to those seeking care.

The bills, both of which passed the House on April 19 and are now in the Senate, aim to combat what supporters say are inequities in access to support systems for people with mental health and substance abuse problems, which have remained stubbornly high. rates after the COVID-19 pandemic.

A bill introduced by state Rep. Lindsey LaPointe, a former social worker who represents part of Chicago’s Northwest Side and chairs the House Mental Health and Addictions Committee, is designed to encourage more behavioral health providers to sign up to commercial insurance networks and, in turn, reduce costs for some who seek their services.

The bill’s language was crafted with the help of Illinois-based mental health organizations, including the Chicago chapter of the National Alliance on Mental Illness and the nonprofit social service agency Thresholds, which treats serious mental health and substance use disorders.

While most of Thresholds’ clients don’t use the types of insurance that this bill would regulate, Heather O’Donnell, the agency’s senior vice president of public policy and advocacy, said the work still matters because it can prevent people from reaching a point. of crisis

“Someone with a serious mental illness needs about 10 years, a solid 10 years, before they can find the right kind of treatment and support to stabilize their condition,” O’Donnell said in an interview. “Imagine a day when it doesn’t take 10 years, it takes one or two months. This is what we should focus on. And people who can access a provider who can help them see the signs of serious mental illness, that’s what we’re fighting for.”

Another bill, introduced by state Rep. Mary Gill of Chicago, would require municipalities across the state to cover couples and family therapy with insurance plans for police officers and firefighters and their spouses.

LaPointes’ bill aims to ensure that mental health or substance use disorder benefits are as favorable as medical or surgical benefits under group health plans and insurance.

According to a report by the nonprofit Research Triangle Institute, based on data collected between 2019 and 2021, nationwide in-network reimbursement levels were about 22 percent lower for behavioral health providers, such as psychiatrists and psychologists, than medical providers such as physician assistants.

As a result, fewer doctors are choosing to accept insurance, leaving patients with fewer options for services if they can’t afford to pay out of pocket, LaPointe said.

Basically, they’re like I’m not going to join an insurance network. If people want to come see me, they can just pay out of pocket, LaPointe said.

The RTI report said patients seeking behavioral health care in the US went out of network 3.5 times more often than those seeking medical and surgical care.

LaPointe said state intervention is needed to correct discriminatory insurance practices and make behavioral health care more accessible. His bill would set a minimum percentage for behavioral health professionals to be reimbursed for care covered by state-regulated commercial insurance plans, which account for about 40 percent of all insurance plans commercial in Illinois.

Reimbursement rates would have to be at least 141 percent of the “Medicare rate for the mental health or substance use disorder service provided,” according to the bill. That number is comparable to the reimbursement rate for physical health services, LaPointe said.

We were talking about a 40% to 50% increase in reimbursement rates, which is a pretty big incentive for providers to actually join the networks, he said.

While the minimum reimbursement rate requirement is the provision with the most impact, other aspects of the bill would also address other issues affecting the affordability of behavioral health services, LaPointe said.

The bill would require insurance companies to cover the work of behavioral health providers who are still in the process of obtaining their licenses and are in training under the direct supervision of a licensed professional. This would quickly expand the options for those seeking support covered by their insurance.

After consulting with practitioners and insurance companies, LaPointe also added to the billing requirements coverage for 60-minute therapy sessions and multiple behavioral health services received on the same day.

What happens is that many people will go to their provider and may have a therapy session and then also see their psychiatrist for 15 minutes, LaPointe said. And what the insurance companies do is they think, Oh, no, we only pay for one of these things…because there’s no law that says they can’t.

He said therapists who accept insurance are currently encouraged to limit their sessions to 45 minutes, as networks often require additional documentation for those trying to bill by the hour. They were driven to give less to people, LaPointe said.

While insurance industry lobbyists continue to speak out against the reimbursement floor, they have not taken issue with the other proposed updates to the statute.

In an interview, Kathryn Morthland, director of policy and advocacy for the Illinois Health and Life Insurance Council, praised the bill’s sponsors for taking insurance companies’ concerns into account.

But he argued that the mandated minimum reimbursement rate could remove incentives for behavioral health professionals who are already paid at a rate above that level. Morthland said the fee requirement “could create a ceiling, rather than a floor,” and negotiations on that provision will continue as the bill moves through the Senate.

While insurance companies would shoulder most of the burden of implementing the requirements, LaPointe said the state would need about $11 million for state employee health plans. He said cost shouldn’t be a major barrier in the grand scheme of things, but it will likely be debated more.

“We’re very behind on behavioral health and like, we’ve been focusing on some other things to keep our heads above water and this is the next natural step,” LaPointe said.

The tighter bill sponsored by Gill aims to close what some mental health professionals say is a gap in insurance coverage for first responders in some Illinois municipalities, including the city of Chicago.

Kathleen McShane, owner and practitioner of Begin Within Therapy Inc. in Chicago, he said many clients with insurance plans through their jobs as police officers or firefighters don’t have coverage for couples or family therapy.

We rarely see it as a denied service” for other insurance plans, McShane said in an interview. That it was specific to this population was especially troubling then.

According to a report from the US Substance Abuse and Mental Health Services Administration, behavioral health conditions such as depression and post-traumatic stress disorder affect first responders 10% more than the general population. Firefighters and police officers also have a higher risk of suicide compared to the general population.

These issues often affect the home lives and spouses of first responders, McShane said.

There is more stress due to the nature of their work; there is stress from the burdens of shift work, he said. You see higher rates of substance abuse. There may be higher rates of domestic violence. It is important to have supports when we have these facts.

The bill introduced by Gill, a Democrat who represents parts of the Southwest Side and the southwest suburbs, would require state, county and municipal insurance plans to cover couples and family therapy for police officers. police and firefighters, as well as their spouses or partners. Without coverage, a single appointment can cost more than $200, a significant barrier for many, McShane said.

The bill passed the House without a dissenting vote and has the support of groups such as the Illinois Counseling Association, the Illinois Sheriffs Association and the Associated Firefighters of Illinois.

Chicago Firefighters Union Vice President Erik Steinmetz said he has been pushing for family and couples therapy coverage for city employees and believes cost is one of the main reasons the first responders do not seek therapy.

“This is one of those things where it saves in the long run if you can get people treatment early,” Steinmetz said in an interview. “It saves some people from losing their jobs and having catastrophes in their lives because of it.”