For months, as the COVID-19 pandemic has raged, Florida first lady Casey DeSantis and top state officials have warned about a looming mental health crisis because of job losses, lockdowns and school closures.
The Legislature might take a small step in trying to determine the fallout.
House and Senate insurance panels this week unanimously approved bills that would require health insurers and HMOs to provide a link to a state consumer website so customers can submit any complaints about their ability to obtain mental health and substance-abuse care.
Under the proposals (SB 1024 and HB 701), the Department of Financial Services would have to annually report to the governor and legislative leaders the number of complaints submitted and how they were resolved. The first report would be due in January 2022.
Senate bill sponsor Jason Brodeur, R-Sanford, told members of the Senate Banking and Insurance Committee on Wednesday that the state currently doesn’t track such complaints from customers with commercial insurance policies or HMO contracts.
He said his goal is have state officials collect and analyze data to learn about coverage gaps that exist under a patchwork of state and federal insurance laws.
“We've all said we want to know what kind of mental health coverage is available in the state of Florida,” Brodeur said. “And there’s no central repository for us as policymakers to be able to know what we should be doing to help enhance those benefits.”
State and federal laws and policies deal with “parity” in coverage for mental health and substance abuse, but the patchwork of regulations doesn’t protect many Florida residents for a variety of reasons. Parity is generally aimed at making benefits for mental health and substance abuse comparable to coverage for other types of conditions.
A 2008 federal law mandating parity, for instance, only applies to businesses with 50 or more employees.
The 2010 federal Affordable Care Act, commonly known as Obamacare, extended the 2008 law to individual policies. It also spelled out 10 essential health benefits that all Obamacare-compliant plans need to meet, including coverage for mental health and substance abuse.
Subsidized health plans sold on a federal insurance exchange created under Obamacare also include mental health and substance-abuse benefits. But the exchange isn’t open to everyone, and Florida didn’t expand Medicaid for working, childless adults who don’t earn enough to qualify for the subsidized plans.
Florida’s insurance code, meanwhile, doesn’t mandate coverage for mental health and substance-abuse treatment. Instead, Florida has what is known as a mandated offering: Insurance companies and HMOs that sell group coverage must make available, at an additional cost, optional coverage for mental and nervous disorders.
Sen. Perry Thurston, D-Fort Lauderdale, said he’s been hearing complaints from constituents and residents for years about availability of mental health and substance-abuse services.
“The families are saying that not until their loved ones are incarcerated do they get any type of mental health treatment,” Perry told Brodeur. “Have you found something different than that?”
Brodeur his goal is to collect data to begin to get a better understanding of what is occurring in the insurance market and whether some people have benefits they aren’t aware of. He also wants to try to ascertain what’s occurring outside the market.
“We are trying to get our hands around what is exactly that gap, how big is it and what can we do as policymakers to close that hole,” Brodeur said.
One in five Americans in 2019 lived with a mental illness, according to the National Institute for Mental Health. The data include people with any mental illness, including mental, behavioral, or emotional disorders that can range from no impairment to mild impairment to severe impairment.
According to the federal Centers for Disease Control and Prevention, requirements associated with COVID-19 such as lockdown orders adversely affected public health. An August report by the agency noted that “symptoms of anxiety disorder and depressive disorder increased considerably in the United States during April-June of 2020, compared with the same period in 2019.”
In addition to creating a repository for complaints, the Senate and House bills would require insurance companies and HMOs to provide customers with state and federal mental health coverage requirements and contact information for a state consumer helpline where customers could call to get a better understanding of their benefits.
Sen. Kelli Stargel, R-Lakeland, said she appreciated how Brodeur was tackling the issue.
“Trying to navigate the mental health world is very challenging. You don’t treat everybody with mental health in the same way you might treat someone with a broken leg,” Stargel said. “It may be that you need weekly visits to talk to somebody. It may be that you need a short-term inpatient visit to get the right medications. Whatever. And I think it’s very prudent to go through and see where are the gaps for the people who are having to navigate this world. So we can make sure what we are offering is the right product and making sure that everyone is aware of what they have.”
Sen. Darryl Rouson, D-St. Petersburg, has focused heavily in the Legislature on efforts to improve opportunities for people with mental health and substance-abuse disorders. Rouson said that he has filed bills for years seeking to require parity for mental health and substance abuse but they never were discussed. Rouson said the Brodeur bill could be the “precursor to parity in Florida.”
“I'm so glad, I’m so glad that we are moving down the highway and we have a date with destiny,” Rouson said.
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