Legislators heard public testimony last week regarding a Senate priority insurance bill that, among other measures, seeks to curb practices by insurance providers that critics say reduce access to care.
S.B. 10 attempts to hold health insurers accountable to comply with regulations requiring what’s known as “mental health parity,” meaning insurance providers cannot place greater restrictions on access to mental health services than on surgical or medical care.
The sweeping legislation also contains several sections that tackle prior authorization, the process by which doctors must obtain approval from insurance companies before providing certain services. The practice received renewed public contempt in the wake of the fatal shooting of United Healthcare CEO Brian Thompson.
“We’re trying to address the health care disparities in the system. It’s never perfect, never 100% but this really goes a long way,” said Sen. Jorge Cabrera, D-Hamden, co-chair of the Insurance and Real Estate Committee and one of the bill’s more than 20 co-sponsors.
Questioning from some committee members, including co-chair Rep. Kerry Wood, D-Rocky Hill, indicated that the legislation will face at least some opposition. But Cabrera said that he’s confident the bill has the votes to advance.
Last year, the Insurance and Real Estate Committee failed to advance any bills before its committee deadline, drawing criticism from committee members and legislative leaders. At the time, House Speaker Matthew Ritter, D-Hartford, chalked it up to “strong personalities” and “years of adversarial relationships.”
This year, the committee has already passed nine bills as of March 10.
Mental health parity
Some people attributed last year’s conflict to disagreements over certain proposals, including a measure on mental health parity, one of the topics that serves as a cornerstone of this year’s Senate priority bill on insurance.
S.B. 10 seeks to enhance enforcement of a state bill passed in 2019 that prohibited carriers from limiting coverage for mental health treatments and required them to submit reports to the state regarding parity. The measure increases the fines the Insurance Department is authorized to issue in cases of noncompliance and requires carriers to identify themselves publicly in their reporting. The current provision allows the insurers to submit those reports confidentially.
Wood said she doubts that the provisions in S.B. 10 would do anything to improve access for patients who currently struggle to obtain mental health services.
Andrew Gerber, president and medical director of Silver Hill Hospital, a psychiatric hospital in New Canaan, testified in support of the bill, saying that he meets with patients every day who can’t access the treatments they need because payers are less likely to provide adequate coverage for mental health treatment. He added that if the state can incentivize payers to compensate providers fairly, providers would be more likely to accept insurance.
“What your issues are will not be solved with this bill,” Wood told Gerber, adding that she agreed with the problems he was raising, but said they were better addressed through solutions like incentives to providers to participate in insurance networks.
Wood did not respond to a request for additional comment.
But State Comptroller Sean Scanlon disagreed, saying that the transparency measures proposed would compel insurers to comply with mental health parity.
“We’re calling out the insurance companies and saying, ‘Put your name on these forms and attest in public to whether you’re complying with this or not. And when you don’t comply with this, we’re going to hit you with a substantial fine,’” Scanlon, who helped write the 2019 bill as a state representative, said during an interview.
Susan Halpin, executive director of the Connecticut Association of Health Plans opposed the bill, saying that the Insurance Department already has sufficient authority to enforce compliance. She also added that revealing the identities of the insurers on reporting documents “could potentially create risks for carriers” in the wake of “the recent violent death of an industry executive.”
Prior authorization
The bill also contains a slew of attempts to tackle prior authorization, which many consumers and advocates complain prevents patients from getting timely and medically necessary care.
“It’s supposed to be a tool for identifying and eliminating waste and fraud in the system. That’s the way it was designed many, many years ago,” Cabrera said. Now, though, he hears from constituents and providers who say they’re “constantly fighting” prior authorization.
The measures include a presumption that care prescribed by a provider is medically necessary, limits on how artificial intelligence should be used in authorization decisions and prohibitions against insurer limits on the use of general anesthesia during surgery.
The anesthesia-related components are a direct response to a proposal from Anthem Blue Cross and Blue Shield last year to institute time limits on anesthesia services, which the company almost immediately reversed following public outcry.