Missouri is the final state to execute a federal law requiring insurance companies to cover mental health care the same as physical ailments.

House Bill 604, sponsored by Rep. Kurtis Gregory, R-Marshall, was signed into law by Gov. Mike Parson in July. The federal law’s enforcement measures will apply to insurers starting Jan. 1, 2022

The proposals, first submitted by Kansas City Democrats Sen. Greg Razer and Rep. Patty Lewis, mandate health insurance plans to comply with the Mental Health Parity and Addiction Equity Act of 2008.

Under the landmark federal law, health insurance providers cannot impose dollar limits or restrictions larger than those for other physical medical conditions. Former President George W. Bush signed it into law.

Activists claim that insurers have identified loopholes to exploit and that state control is important.

Mental health difficulties could worsen if the federal law is not enforced, according to David Lloyd, senior policy advisor at The Kennedy Forum, which monitors federal law enforcement nationwide. Former Congressman Patrick J. Kennedy started the nonprofit in 2013.

Lloyd said it’s “better late than never” that Missouri is enforcing the federal law.

In terms of who was in charge of overseeing commercial insurance plans that are fully covered, it was almost a no man’s land, according to Lloyd.

In a 2019 GAO assessment examining the law’s enforcement, states differed in the frequency and type of reviews done, and federal oversight measures were unclear.

A GAO survey indicated that only Missouri and Wyoming did not undertake parity evaluations before approving plans for sale. According to the report, the CM&MS and HHS were in charge of parity enforcement in four states, including Missouri and Wyoming.

While Missouri recently enacted the federal act, some states, including California, have gone further to fill in the gaps.

People who have been restricted in their therapy sessions have contacted Lewis, a former intensive care unit nurse and health care executive.

“Mental illness is persistent. It’s the same as going to see your cardiologist for whatever reason you need. It’s unlimited,” Lewis remarked. Not like, ‘You’ve seen your cardiologist three times.’ You’re done. You’re out.’ But we see it with mental health.”

Similar issue In conversations with Kansas City firemen, Razer learned that they had limits on how many times they could see a mental health specialist, regardless of the damage they had suffered.

Kansas City Democrat Greg Razer
Kansas City Democrat Greg Razer (Missouri House Communications photo by Tim Bommel)
Razer said a member of his staff heard a 2019 KCUR piece highlighting the state’s delay of action and the potential impacts on Missourians in need of services. Anxiety, sadness, and suicidal thoughts are on the rise, according to Razer and Lewis.

In the future, mental health will be recognized as a medical issue, Razer hopes.

Razer and Lewis said insurers have to make concessions. Plans with a duration of 12 months or less, plans prior to the Affordable Care Act that did not cover mental health, and other supplemental insurance determined by the Department of Commerce and Insurance (DCI) director are excluded.

“They’re in business to earn money,” Razer said of health insurance carriers.

In April, Shannon Cooper, a spokeswoman for America’s Health Insurance Plans, testified that insurers supported Lewis’ measure. But he warned lawmakers against codifying federal regulations that can change frequently, making DCI ineffective.

The Missouri Insurance Coalition, whose members include Blue Cross/Blue Shield of Missouri, stated it had no issues with the mental health parity rules. DCI may take enforcement proceedings against the alliance, but Koch said the coalition will continue to follow state and federal laws.

According to Koch, the amendment essentially codified federal legislation that our member companies already followed. “The language appears to have broad bipartisan support and should benefit Missouri consumers.”

DCI said Missourians shouldn’t notice a difference in their mental health coverage because providers are obligated to comply with the federal statute since 2008.

“The Department’s ability to protect consumers will be enhanced by permitting it to enforce federal law,” said Lori Croy, a department spokesperson.

Croy says much of the implementation will be internal. Croy said DCI has gone out to the US Department of Health and Human Services to start dialogue and collaboration.

Assuring parity compliance requires aggressive oversight, including reviewing plans for parity before they are marketed, investigating complaints for parity violations that customers may not be aware of, and looking at plans’ parity compliance studies to verify compliance.

“It’s not enough to have a parity-compliant policy on paper and then make judgments that discriminate against people with mental health and addiction challenges,” Lloyd said.

Lloyd cited Texas and New York as states that enforce strongly. Recently, the NY AG and the US Department of Labor announced a $15 million settlement with UnitedHealthcare over claims the health insurer unfairly curtailed outpatient psychotherapy coverage.

While the department’s actions in Missouri are unknown, Lewis hopes the department is honest in its efforts.

In Lewis’ words, “lives are on the line.”

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