The Office of the Insurance Commissioner applied for and received a two-year, $284,000 federal grant to evaluate consumer access to services for mental health and substance use disorders in state-regulated individual, small group, and large group health insurance plans.
The grant is made possible by the Affordable Care Act and is funded through the Centers for Medicare and Medicaid Services and the Center for Consumer Information and Insurance Oversight. It runs from August 2018 - July 2020.
The goal of the project is to determine whether or not state-regulated health insurers are offering comprehensive and affordable access to mental health services and treatment for substance use disorders, identify the causes of any access issues, and propose solutions for improvements.
We will examine health insurers' benefit designs, their policies and procedures, and their claims data related to access to mental health and substance use disorder treatment services, including alternatives to opioids for treating pain. The data collection and analysis will involve two phases:
- Phase one - Issue two market scans to identify any barriers to mental health and substance use disorders services as well as services for pain treatment. Contract with a consultant to review insurers' medical necessity and prior authorization criteria for these services.
- Phase two - Conduct detailed claims analysis based on results from the market scans and the consultants' findings.
Results of the market scans and analysis along with any recommendations will be included in a final report.
Project staff will be assisted by a 25-member advisory committee made up of consumer advocates, behavioral health and medical providers, and health insurer representatives. The committee will meet throughout the project duration to discuss scope, review findings, and make recommendations.