Kansas Mental
Health Coalition

April 27, 2010

 

Linda Sheppard

Director, Accident & Health Division

Kansas Insurance Department

420 SW 9th Street

Topeka, KS 66612

 

Dear Linda:

 

The Kansas Mental Health Coalition is in the process of reviewing the impact of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2009 on consumers and providers. The Act took effect January 1, 2010.

 

1) The Wellstone-Domenici Act addresses "limitations to treatment." In particular, medical-surgical treatment and mental health treatment must be equal. While the Act does not prohibit the use of gate keeping and utilization review by the managed care industry, the Act does require that such practices be comparable for mental health and medical-surgical services.

 

Many insurance companies retain independent or wholly owned "carve-out behavioral health" companies to manage mental health services. These companies then approve mental health inpatient treatment and out-patient services a few days/sessions at a time.

There is no illness in medicine that results in the creation of a separate corporate structure (behavioral health carve-outs) to provide gate keeping and utilization review  to the extent that is done for mental illness.

 

On the medical-surgical side of medicine there is the presumption by the insurance industry that both patient and doctor are knowledgeable and competent to determine when access to medical services is required.

 

The existence and functions of carve-out behavioral managed care companies is based on the different presumption that the consumer and doctor are not able to determine when services are needed; consumer and doctor must therefore seek "permission" from the managed care company to access services. This different treatment for mental health services appears to violate the spirit and intent of the Wellstone-Domenici Act.

 

We are asking that KID look into this matter to determine whether the routine activities of behavioral health companies violate the Wellstone-Domenici Act and if so to issue a cease and desist order to these companies.

 

 2) Insurance companies carefully watch the utilization of hospital days for medical-surgical services, but we are not aware of day by day authorization of out-patient medical treatment. Patients are not told they can only see their internist, or pediatrician, or cardiologist for three sessions. Pre-authorizing sessions, 3, or 6, or 8 sessions at a time is quite common for consumers accessing mental health treatment. While some ancillary treatments such as physical therapy may be authorized in this manner, we know of no primary medical treatment for a primary medical condition that undergoes comparable scrutiny and authorization.

 

In summary, we are asking KID to look into the way the insurance industry currently manages mental health services in Kansas and to evaluate whether current practices are in compliance with the spirit, intent, and letter of the law of the Wellstone-Domenici Act and current Kansas statues and regulations. Are patients seeking mental health treatment offered the same access and level of oversight by the insurance industry as those seeking medical/surgical treatment? - or are there greater restrictions and limitations to treatment placed on patients seeking mental health treatment?

 

Thank you for looking into these matters.

 

Sincerely,

 

 

 

Roy Menninger, MD, Chairperson

Board of Directors

Kansas Mental Health Coalition

 

cc:      Steven Six

          Kansas Attorney General

 

          HHS Secretary Kathleen Sebelius


(c) Kansas Mental Health Coalition, P.O. Box 4103, Topeka, KS  66604-0103         785-969-1617

Powered by Wild Apricot Membership Software