May 21, 2019

Senator Warren, Rep. Kennedy Reintroduce Behavioral Health Coverage Transparency Act, Legislation to Prevent Discrimination Against Patients Seeking Mental Health and Addiction Care

Weak enforcement of existing laws has allowed insurance companies to continue illegal discrimination under the radar; Warren, Kennedy bill would increase oversight, resources to stop behavioral health discrimination

Bill Text (PDF) | One Pager (PDF) | Op-Ed 

Washington, DC - Today, United States Senator Elizabeth Warren (D-Mass.) and Representative Joe Kennedy III (D-Mass.) will lead their colleagues in the Senate and House in reintroducing their legislation, the Behavioral Health Coverage Transparency Act, to increase oversight and enforcement to ensure that insurance companies cover behavioral health benefits and services on par with physical health benefits and services.

"Patients with behavioral health concerns deserve the same access to care as patients with physical health conditions, but for far too long, insurance companies have unfairly denied behavioral health care services to cut costs," said Senator Warren. "Our bill would put a stop to these discriminatory practices and make sure patients get the treatment they need."

"For generations, we have allowed stigma and silence to deny patients the mental health care and substance use disorder treatment they need and deserve," said Congressman Kennedy. "We would never build barriers to care for a neighbor with broken bones, heart disease or cancer, and we cannot tolerate insurers building them for anyone with depression, an eating disorder or anxiety. By passing this bill, we can increase transparency for patients navigating our behavioral health care system, and bring accountability to any companies attempting to skirt existing laws."

Their reintroduction comes in the aftermath of a federal judge's ruling in favor of over 50,000 patients who sued the nation's largest health insurer, UnitedHealth, for cutting costs at patients' expense and preventing them from getting recommended treatment unless their behavioral health issue was an emergency.

Mental health and substance use disorder coverage discrimination was banned in 2008, when Congress passed the Mental Health Parity and Addiction Equity Act, but weak enforcement has allowed insurance companies get away with discrimination under the radar. A survey conducted by the National Alliance on Mental Illness found that nearly twice as many respondents had been denied coverage for mental health care as for general medical care. Another report found that patients sought mental health and substance use disorder treatment out-of-network almost three to six times more often than they sought physical care out-of-network.

Originally introduced in the Senate in 2016 and again in 2018, The Behavioral Health Coverage Transparency Act would:

  • Require insurance issuers to disclose to federal regulators how they are making parity decisions, and the rate and reasons for denials of mental health claims;
  • Require regulators to conduct no fewer than 12 random audits of health plans and to make public the results of those audits; and
  • Establish a Consumer Parity Unit that gives consumers a single place to get information about their rights and to submit complaints with assurance of timely responses.

The legislation is co-sponsored by U.S. Senators Edward J. Markey (D-Mass.), Sherrod Brown (D-Ohio), Richard Blumenthal (D-Conn.), Tammy Baldwin (D-Wis.), Tina Smith (D-Minn.), Cory Booker (D-N.J.), Bernie Sanders (I-Vt.), Debbie Stabenow (D-Mich.), Tim Kaine (D-Va.), Kamala Harris (D-Calif.), Maggie Hassan (D-N.H.), Jeanne Shaheen (D-N.H.), Chris Van Hollen (D-Md.), Kirsten Gillibrand (D-N.Y.), Amy Klobuchar (D-Minn.), and Chris Murphy (D-Conn.).

It has received support from the following advocacy and expert organizations:

A New PATH (Parents for Addiction Treatment and Healing), American Art Therapy Association, American Association for Geriatric Psychiatry, American Association of Child & Adolescent Psychiatry, American Counseling Association, American Group Psychotherapy Association, American Psychological Association, American Society of Addiction Medicine, Association for Behavioral Healthcare, Children and Adults with Attention-Deficit Hyperactivity Disorder (CHADD), Community Catalyst, Depression and Bipolar Support Alliance, Eating Disorders Coalition, Faces and Voices of Recovery, Facing Addiction with NCADD, Global Alliance for Behavioral Health and Social Justice, Jewish Federations of North America, Massachusetts Medical Society, Mental Health America, NAADAC, the Association for Addiction Professionals, National Alliance on Mental Illness, National Association for Children's Behavioral Health, National Board of Certified Counselors, National Council for Behavioral Health, National Eating Disorders Association, National Register of Health Service Psychologists, National Safety Council, NHMH - No Health without Mental Health, Residential Eating Disorders Consortium, School-Based Health Alliance, SMART Recovery, Student Coalition on Addiction, The American Osteopathic Academy of Addiction Medicine, The Kennedy Forum, Treatment Communities of America, and Young People in Recovery.

"The Association for Behavioral Healthcare and our member organizations strongly support the Behavioral Health Coverage Transparency Act.  As providers of behavioral health services, our members see first-hand the difficulty their clients face in accessing timely treatment because of insurance barriers.  Our members frequently note that these barriers are in sharp contrast to when their clients are seeking physical health care.  Senator Warren and Congressman Kennedy are right to fight to strengthen parity laws.  Behavioral health care must be made as accessible as physical health care," said Vic DiGravio, President/CEO of the Association for Behavioral Healthcare.

"Today ASAM commends Senator Warren and Representative Kennedy for their efforts to strengthen parity for mental health and addiction benefits. By requiring insurance issuers to disclose the analysis they perform in making parity determinations, random audits by federal regulators, the review of denial rates for mental health versus medical claims, and the establishment of a consumer parity portal, the Behavioral Health Coverage Transparency Act of 2019 will help ensure equitable access to comprehensive addiction treatment for all," said Paul H. Earley, MD, DFASAM, president of ASAM.

"Strengthening parity protections for people with addiction will have a long-term, positive impact on increasing access to treatment and reducing overdose. The Behavioral Health Coverage Transparency Act details a thoughtful and actionable approach that supports this outcome," wrote 11 members of the Coalition to Stop Opioid Overdose. Read their full letter of support here.

“The Massachusetts Medical Society applauds legislation brought forth by Sen. Warren and Rep. Kennedy that will address gaps in transparency and in adherence to laws that afford patients the care and coverage they need and are guaranteed to address their mental health.  Despite the existence of parity laws, there are still inexcusable inequities in coverage. As physicians, we recognize that mental health services are every bit as medically necessary and imperative as any medical need we treat each day.  Many of our patients with mental health concerns already face significant and dangerous obstacles of stigma and access.  The very last thing our patients need is a confusing authorization process and financial burden standing between them and mental health treatment that can improve and save their lives. The 25,000 physician and medical student members of the Massachusetts Medical Society support this bill and we look forward to its impact in eliminating coverage gaps and inscrutable decision-making that threaten the mental health and the lives of our patients," said  Maryanne C. Bombaugh, President, Massachusetts Medical Society.

Read Senator Warren and Representative Kennedy's op-ed in the Boston Globe in support of their bill here.