Colorado, Virginia, Washington advancing bills on mental health and substance use disorder parity
The Colorado Health and Human Services Committee last week voted unanimously to advance a mental health and substance use (MH/SUD) disorder parity bill that would further strengthen Colorado’s MH/SUD parity laws and prevent health insurance companies from inappropriately delaying and denying care.
Colorado House Bill 25-1002 (PDF) would establish a standard definition for what is the “generally accepted standard of care”—tying the definition to medical criteria relied upon by physicians, including those developed by non-profit, professional medical associations, such as the American Society of Addiction Medicine (ASAM) criteria, LOCUS, CALOCUS-CASII, and ECSII, supported by the American Academy of Child and Adolescent Psychiatry (AACAP) and American Association of Community Psychiatrists. The Colorado Medical Society, Colorado Society of Addiction Medicine (COSAM), Colorado Child & Adolescent Psychiatric Society (CCAPS), Colorado Psychiatric Society (CPS) and the AMA all support the bill.
“Colorado physicians will always stand up for our patients,” said Colorado Medical Society President-elect Brigitta Robinson, MD. “This legislation is the next step to providing the necessary clarity to health insurance companies that medical necessity determinations are best made by relying on the best medical evidence and expertise—not payer-driven policies.”
“Health plans’ failure to cover physician-recommended care that is consistent with generally accepted standards of care results in significant harm to patients and society,” AMA Executive Vice President and CEO James L. Madara, MD, wrote to the committee (PDF) in support of the bill. “When patients are unable to afford timely, appropriate services due to health insurance denials, their conditions and overall health frequently worsen, which can lead to preventable emergency department visits, hospitalizations, higher overall health care costs, and harm and suffering for the patient and his/her family.”
“HB 25-1002 is essential legislation to clearly define the components of parity in our state and empower state agencies with enhanced tools to oversee payers,” said Stephanie Stewart MD, COSAM President-Elect. “Crucially, this legislation requires that medical necessity determinations are made in accordance with criteria and guidelines from non-profit clinical specialty association standards.”
“House Bill 1002 is good, common-sense legislation that provides transparent, universal tools to determine what is fair coverage for the people of Colorado,” said Chris Rogers, MD, a child psychiatrist in Colorado representing CCAPS and CPS. “It will allow families to focus on healing in a time when their loved ones need to be their focus—not trying to figure out how they are going to find or pay for care.”
Similar bills supported by the AMA have been introduced in Washington (PDF) and Virginia. The Virginia bill passed the Viriginia House of Delegates 79-19 and will soon be considered by the state Senate.
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