Legislature(2011 - 2012)BUTROVICH 205
02/28/2011 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB27 | |
| SB52 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 27 | TELECONFERENCED | |
| *+ | SB 52 | TELECONFERENCED | |
SB 52-MENTAL HEALTH CARE INSURANCE BENEFIT 1:45:29 PM CHAIR DAVIS announced the next order of business would be SB 52. TOM OBERMEYER, Staff to Senator Davis, said that SB 52 amends several sections of Alaska's health insurance code to require that health care insurers provide full "parity," i.e., equal insurance coverage, or the same financial and treatment coverage for mental health conditions, including alcohol and substance abuse, as other physical illnesses. This bill expands on state compliance under HB 222 in 2009 with newly enacted federal parity law, the "Paul Wellstone and Peter Domenici Mental Health Parity and Addiction Equity Act" of 2008. That Act also applies to all children's health insurance programs and became effective April 1, 2009. 1:49:30 PM MR. OBERMEYER said that historically, health insurers have been reluctant to cover mental health and substance abuse services on the same basis as general medical and surgical services. During the 1980s many states required insurers to provide coverage for mental health services and to offer freedom of choice among providers. However, concerns about the adequacy of this coverage persisted because insurers imposed increased cost sharing or restrictive benefit limits. This led to more federal and state intervention on behalf of consumers. While current federal law does not mandate that group plans must provide mental health coverage, if they do, they must provide the same financial and treatment coverage offered for other physical illnesses. This bill differs from federal law in that it does mandate that "a health care insurer which offers, issues for delivery, delivers, or renews a health care insurance plan to an employer or individual on a group or individual basis shall provide coverage for treatment of a mental health condition." CHAIR DAVIS asked if he could provide a sectional analysis. MR. OBERMEYER said that Section 1 prohibits a health care insurer from placing a greater financial burden on an insured for the treatment of alcoholism or drug abuse than for other medical care, including limits on payment, deductibles, copayment, or other cost sharing requirements, methods, prenotification requirements, limiting or excluding coverage or services, or denying coverage because treatment was interrupted or not completed. It defines a "health care insurance plan" and "health care insurance." Section 2 requires health care insurers to provide coverage for treatment of mental health conditions. It requires that health care insurance provisions are applied to the treatment of mental health conditions in the same way as those health care insurance conditions are applied to other medical care. Section 3 is an editorial amendment. Section 4 removes limitations on mental health benefits from ACHIA high risk plans. Section 5 removes a 50 percent copayment requirement for mental health services under an ACHIA plan. Section 6 removes a provision under an ACHIA plan that requires certain expenses for the treatment of mental and nervous conditions be paid at the rate of 50 percent. Section 7 removes the exclusion for mental health services or services for alcohol or drug abuse from the definition of "basic health care services" which applies to health maintenance organizations. Section 8 changes the definition of medical care and includes mental health care and care for alcoholism and substance abuse in the definition of "medical care" for insurance purposes. Section 9 repeals the definition of "medical and surgical benefits" applicable to health insurance, which excludes mental health benefits. It also repeals the definition of "mental health benefits," which allows the term to be defined in a health care insurance plan, and which excludes treatment of substance abuse or chemical dependency. Section 10 states that the act applies to insurance issued after the effective date of the act. Section 11 states that the act applies to insurance issued after the effective date of the act. Section 11 states an effective date. 1:55:00 PM MR. OBERMEYER explained that SB 52 tries to recognize that mental health conditions must be defined in the DSM manual, and he asked DSHS to confirm that those disorders are defined there. From a policy standpoint, SB 52 recognizes that these conditions should be treated under health plans the same as other medical conditions. He noted that DUI wellness court clients have been found to be medically (chemically) dependent. It is only fair to treat these conditions the same as other conditions. Treating them otherwise is discriminatory. SENATOR MEYER asked if he had any idea what this would cost small business. MR. OBERMEYER answered that the fiscal note indicates some anticipated costs. He assumes that if law were put into effect, fewer employers might offer insurance or fewer employees might enroll. They don't have good numbers, but other states have done this. There must be some ability to justify the additional costs, because 46 states have some type of parity laws, including 28 that require full parity for mental health benefits. CHAIR DAVIS said we don't know how much it will cost small business. But we do know that parity is possible. In the long run it may end up saving money. We should provide parity for people with mental illness simply because it's the right thing to do. SENATOR MEYER said he did not disagree with that. CHAIR DAVIS said there is no way of knowing the cost. Many employers who don't have to provide this coverage are already doing it. SENATOR EGAN noted that if a small business participates already, the bill would not affect them. MR. OBERMEYER said if a private company has a plan in effect now, the bill says they would have to have full parity. If they don't have a plan now and they elect not to have one, then they are not required to have mental health parity. This bill says you must have full parity for mental health coverage if you have a plan. 2:03:09 PM SENATOR MEYER said the federal Mental Health Parity Addiction Act says any employer with fewer than 50 employees is exempt. SB 52 says any employer with more than 5 must participate, and he wondered why that number was chosen. MR. OBERMEYR said he was not sure. DENNIS BAILEY, Attorney, Legislative Legal Services, said he doesn't know where the number came from or why it is in the bill. CHAIR DAVIS stated, "We can see we have work to do on this bill." She said she was not sure what the number should be, but the issue needs to be addressed. SENATOR MEYER asked if substance abuse and mental health are typically lumped together. MR. OBERMEYER said that DSHS has experts on this question, and the DSM manual defines these conditions. Alcoholism and substance abuse are now considered mental health disorders. SENATOR MEYER asked if this bill would be able to distinguish between mental health claims and substance abuse claims. MR. OBERMEYER said they would both be included under the same definition. DENNIS BAILEY said that he did not have a definitive answer, but looking at information on DSM standards he thinks there are separate designations of a disorder that are alcohol related versus other disorders that are non-alcohol related. They are a sub-category of mental illness. 2:09:29 PM CHAIR DAVIS said there was someone present from the Division of Behavioral Health. 2:10:32 PM BRENDA KNAPP, Treatment and Recovery Program Administrator, Division of Behavioral Health (DBH), Department of Health and Social Services (DSHS) said her purpose was to answer questions on the fiscal note. DSHS submitted a zero fiscal note. The DBH recognizes the value of having insurance coverage for mental health and substance abuse issues. Looking at the impact of this parity bill with regard to a fiscal note, research did not indicate a significant cost increase or savings. 2:11:51 PM SENATOR DYSON joined the meeting. SENATOR MEYER asked if SB 52 would have much impact to the state, and noted that impacts would be mostly to small businesses, whether anything under 50 or over 5 employees. MS. KNAPP answered that DSHS would not track that. They would be tracking Medicaid expenditures, reduced need for treatment paid by DSHS, increased need for treatment facilities and oversight. The bill would not impact them directly at this time. SENATOR MEYER said you might actually see a decrease. MS. KNAPP answered that she was not an insurance expert. SENATOR MEYER asked if the Division of Insurance has taken a position. MS. KNAPP answered she was not aware that they had. CHAIR DAVIS said they usually remain neutral, but we can ask that they come forward. SENATOR MEYER said he was referring to Linda Hall. CHAIR DAVIS said the committee could ask her to come to the next hearing. 2:15:55 PM SENATOR EGAN asked if a small business does not have health insurance for their employees, would this bill require them to provide insurance. CHAIR DAVIS said if you have a plan you have to do things, but the bill is not saying you have to get a plan. SENATOR DYSON noted on page 2, line 19, there would seem to be one factor that makes employers reluctant to have parity because a diagnosis of mental illness is more subjective. The bill says an insurer may not use or require notification or a second opinion. He stated he would enjoy knowing why a second opinion was excluded. CHAIR DAVIS said they could list this as an area of concern. She said they would look into this area. SENATOR DYSON asked about the meaning of fraternal benefit society as used in SB 52. DENNIS BAILEY said that a fraternal benefit society is a group that provides benefits for its members, such as the Moose Lodge or the Elks Lodge, where they may give some insurance type benefits to their members. These are categorized separately from a normal health insurer. SENATOR DYSON said some unions, including those representing public employees, have their own health benefit plans, and asked if they would be required to comply. MR. BAILEY said he had some ideas on the question, but felt it should be directed to the Division of Insurance. CHAIR DAVIS announced that SB 52 would be held in committee for further consideration.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 52 Sectional Summary 2-21-2011.pdf |
SHSS 2/28/2011 1:30:00 PM |
SB 52 |
| SB 52 Sponsor Statement Rev 2-12-2011 docx.pdf |
SHSS 2/28/2011 1:30:00 PM |
SB 52 |
| SB 52 Suport Docs - Legal Svcs Memo 091010.pdf |
SHSS 2/28/2011 1:30:00 PM |
SB 52 |
| SB 52 Support Docs - NCSL State Comparisons 2010.pdf |
SHSS 2/28/2011 1:30:00 PM |
SB 52 |
| SB 52 Support Docs-DSM-IV-TR - Diag Man Mental Disorders.pdf |
SHSS 2/28/2011 1:30:00 PM |
SB 52 |
| SB 52 Support Docs-MH Parity -42 USCS 300gg-23 preemption.pdf |
SHSS 2/28/2011 1:30:00 PM |
SB 52 |
| SB 52 Support Docs-MH Parity-42 USCS 300gg-26-subst abus (3).pdf |
SHSS 2/28/2011 1:30:00 PM |
SB 52 |
| SB 52 Bill.pdf |
SHSS 2/28/2011 1:30:00 PM |
SB 52 |