Tool will help policymakers increase access to mental health and addiction care amid historic rates of overdoses and suicides across the nation
Washington, D.C., December 10, 2020 – Today, The Kennedy Forum released the Jim Ramstad Model State Parity Legislation, which will hold health insurers accountable for discriminating against those with mental health and substance use disorders by wrongly denying coverage of care.
Jim Ramstad served in the U.S. House of Representatives from 1991-2009, representing Minnesota’s 3rd congressional district. He joined former Democratic Rep. Patrick J. Kennedy as the lead Republican cosponsor of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which requires insurers to cover treatment for mental health and substance use disorders no more restrictively than treatment for illnesses of the body, such as diabetes and cancer.
The new model bill named for Rep. Ramstad, who passed away in November, is based off of California’s groundbreaking new law, Senate Bill (SB) 855, which The Kennedy Forum spearheaded earlier this year (SB 855 takes effect on January 1, 2021). View the model legislation in its entirety here.
The legislation was developed in partnership with the American Psychiatric Association, the American Psychological Association, NAMI, Mental Health America, the National Council for Behavioral Health, and more than 30 additional national organizations. The American Psychiatric Association is currently working to tailor it to all 50 states’ unique codes so that advocates can work rapidly to enact its requirements across the country.
Both SB 855 and the model bill would require that all insurers follow generally accepted standards of behavioral health care when making medical necessity decisions, and use criteria consistent with these standards. By putting these critical requirements in place, states can improve access to mental health and addiction care at a time of rapidly escalating needs.
“Our nation was in the midst of mental health crisis before COVID began,” said former Congressman Patrick J. Kennedy, founder of The Kennedy Forum. “We cannot meet the increasing mental health needs of Americans and fully recover from this pandemic if our insurers are not being held accountable for treating the brain on par with the body.”
Generally accepted standards of care were addressed in detail in a recent landmark federal class-action ruling, Wit v. United Behavioral Health (UBH), which found the nation’s largest insurer was using flawed medical necessity criteria to wrongly deny mental health and addiction coverage to more than 50,000 patients nationwide, half of whom were children or adolescents. The court also found that United used flawed medical necessity criteria to “mitigate” compliance with the MHPAEA.
Last month, the federal court issued a 10-year injunction against UBH, ordering it to reprocess approximately 67,000 denied mental health and addiction claims and to use criteria from non-profit clinical specialty associations, such as the American Society of Addiction Medicine, which are consistent with generally accepted standards of care.
Alarmingly, the use of flawed medical necessity criteria that allow insurers to wrongly deny mental health and addiction coverage is commonplace. In a recent review of mental health criteria, for example, the New York Office of Mental Health found all plans’ criteria to be flawed. By using flawed criteria, insurers often inappropriately limit mental health and addiction coverage to treating short-term symptom reduction, while refusing to cover ongoing treatment for chronic mental health and addiction conditions.
“This Model Legislation will enable states to ensure patients actually receive care that is in line with accepted clinical standards,” said American Psychiatric Association President Jeffrey Geller, M.D., M.P.H. “The legislation is crucial in defeating discrimination against those with mental health and substance use disorders. The American Psychiatric Association encourages the states to enact it so patients receive the care they deserve.”
“The American Psychological Association supported California S.B. 855, and we are now pleased to promote the Ramstad Model State Legislation to benefit people in other states,” said Arthur C. Evans Jr., PhD., CEO of the American Psychological Association. “Requiring insurers to make mental health coverage decisions based on clinical and scientific expertise – instead of their bottom line – is the right thing to do for the well-being of our citizens and communities.”
The Kennedy Forum stands ready to assist advocates and policymakers across the nation in utilizing the Jim Ramstad Model State Parity Legislation in their states.
The following organizations have endorsed the legislation: American Academy of Child & Adolescent Psychiatry, American Association for Marriage and Family Therapy, American Foundation for Suicide Prevention, American Psychiatric Association, American Psychological Association, American Psychoanalytic Association, The Carter Center, Chronic Disease Coalition, Community Catalyst, Council of Autism Service Providers, Depression and Bipolar Support Alliance, Eating Disorders Coalition for Research, Policy & Action, Faces and Voices of Recovery, Families USA, Inseparable, Mental Health America, NAMI, The National Alliance to Advance Adolescent Health, National Association for Behavioral Healthcare, National Association for Children’s Behavioral Health, The National Association for Rural Mental Health, National Association of Addiction Treatment Providers, National Association of County Behavioral Health and Developmental Disability Directors, National Association of Social Workers, National Council for Behavioral Health, National Eating Disorders Association, National Federation of Families, National Register of Health Service Psychologists, Partnership to End Addiction, Psychotherapy Action Network (PsiAN), Residential Eating Disorders Consortium, Shatterproof, Treatment Advocacy Center, The Trevor Project, The Voices Project, Well Being Trust, and 2020 Mom.
Other key partners of the Jim Ramstad Model State Parity Legislation have shared their support:
“Too many insurance companies have been making up their own rules to justify denying access to critically needed treatment, with devastating outcomes,” said NAMI CEO Daniel H. Gillison Jr. “NAMI is proud to support model legislation which, if enacted, will be a major step forward in the fight to get people the mental health care they need and deserve.”
“It has never been more important to ensure access to mental healthcare. During COVID- 19, MHA’s screening data shows alarming increases in anxiety, depression and suicidal thoughts, especially for youth and young adults,” said Paul Gionfriddo, president and CEO of Mental Health America. “Enacting this model legislation throughout the country will ensure that we can intervene early and prevent crises, just as we do for other health conditions.”
“COVID-19 has accelerated and expanded our country’s mental health and substance use disorder crisis. Access to treatment – when and where people need it – remains the biggest challenge we face,” said Chuck Ingoglia, president and CEO, National Council for Behavioral Health. “Unfortunately, insurers have consistently fought to illegally deny equitable coverage and states have lacked the tools to hold them accountable. No longer. This model legislation would allow states to properly enforce the law by requiring insurers adhere to consistent, stringent and accepted standards of coverage for mental health and substance use disorders. We look forward to working with our members and state partners to support the introduction of this legislation. Together, we can achieve the full potential of the Mental Health Parity and Addiction Equity Act.”
About The Kennedy Forum
Founded in 2013 by former Congressman Patrick J. Kennedy (D-R.I.), The Kennedy Forum leads a national dialogue on transforming the health care system by uniting mental health advocates, business leaders, and policymakers around a common set of principles, including full implementation of the Federal Parity Law. Launched in celebration of the 50th anniversary of President Kennedy’s signing of the landmark Community Mental Health Act, the nonprofit aims to achieve health equity by advancing evidence-based practices, policies, and programming for the treatment of mental health and addiction. The Kennedy Forum’s “Don’t Deny Me” campaign educates consumers and providers about patient rights under the Federal Parity Law and connects them with essential appeals guidance and resources. To learn more about The Kennedy Forum and donate, please visit www.thekennedyforum.org.