Four years after the Texas Legislature passed legislation aimed to improve health plan coverage of mental health conditions and substance use disorders, a state workgroup has released a strategic plan to improve compliance with the law’s protections to put coverage of those treatments on par with other types of health care.
House Bill 10 expanded the Texas Department of Insurance’s power to enforce how health insurance plans cover these conditions. It also created the Mental Health Condition and Substance Use Disorder Parity Work Group, whose members were tasked with developing a state strategy for successful compliance.
“Historically, coverage for treatment of [mental health conditions and substance use disorders] has been inferior, as compared with treatment for other types of medical conditions,” the plan’s authors wrote. “For example, an insurer provides unlimited doctor visits for a condition like diabetes but limits visits for [substance use disorders] or [mental health conditions] like major depression or schizophrenia.”
Texas ranks 44th in the nation for the rate of adults with mental health issues not receiving treatment, and nearly two-thirds of Texas children with a major depressive order receive no services at all, according to Mental Health America.
Austin psychiatrist and internist Thomas Kim, MD, says legislative loopholes have allowed payers to bypass such coverage parity requirements. For example, federal parity law requires payers to provide equal coverage if mental health care coverage is offered but does not require that they offer it in the first place. Similarly, state law does not require insurers to pay for mental health care at the same rate as other types of medical care, which prompts some physicians not to accept insurance, leading to patchy networks, according to the workgroup.
But Dr. Kim is hopeful the new strategic plan will give the quest for parity some teeth.
“The plan, to me, is both demoralizing in the lack of progress we’ve had in parity, and incredibly inspiring in that we’re being transparent about that,” said Dr. Kim, who testified for the Texas Medical Association in 2017 in support of House Bill 10 by Rep. Four Price (R-Amarillo).
In the new report, the workgroup issued 26 recommendations, which largely focus on state lawmakers and agencies. Some affect physicians directly, including calls for:
- The end of “fail-first” or step therapy requirements for mental health medications;
- The use of Medicaid funds for residential treatment for mental health conditions;
- The provision of telehealth services for mental health care to the same extent they are available for other medical problems; and
- The removal of treatment limitations for substance use disorder coverage from the adult Medicaid program.
The workgroup also directed the Texas Health and Human Services Commission (HHSC) and the insurance department to develop complaint processes so patients experiencing coverage problems can pursue their claims.
If heeded, TMA Director of Legislative Affairs Michelle Romero says this would be a sign the state is taking its oversight responsibilities seriously given that health insurance plans don’t always comply with the existing protections.
Dr. Kim agrees but cautions the recommendations will likely take years to make a dent in a broken system. “We’re turning a huge streamliner,” he said.