July 1st, 2013

Legislation seeks to curb treatment interruption

Proposed Massachusetts legislation would allow behavioral health patients to continue receiving the same care when insurance companies do not renew provider contracts.

Current state law prohibits health plans from terminating contracts without due cause, but the proposed Bill H. 1783, filed by Rep. Ruth Balser (D-Newton), would require insurance carriers to give at least 180 days notice to behavioral health providers if a contract is not going to be renewed and to show cause for not renewing provider contracts and demonstrate that any lawful communication concerning regulations and statutes that affect service delivery is not a factor in said non-renewal. The bill also states that existing patients be allowed to continue treatment until no longer medically necessary consistent with terms of the contract in place at the time of non-renewal.

“This is an attempt at really protecting mental health consumers from having their treatments interrupted by virtue of what might potentially be arbitrary changes on the part of the health plan,” Balser says.

Michael A. Goldberg, Ph.D., director, Child & Family Psychological Services Inc./Integrated Behavioral Associates, spoke in favor of the bill to the Joint Committee on Mental Health and Substance Abuse.

Goldberg says that while state law prohibits plans from “terminating” contracts with providers without cause, this legislation would help prevent health plans from finding a way around that law by issuing contracts to health providers that have one-year terms that automatically renew annually unless either party provides notice of “non-renewal.”

“There are also situations in which health plans are bought by other plans and the new plan terminates the old plan’s contract for patients in care and replaces with their new contract, often at substantially lower rates,” Goldberg says. “This creates an avenue in which clinicians, sensitive to the harm that interrupted care may cause patients, reluctantly accept contracts that otherwise do not reflect the normal economic forces in the marketplace.”

The bill also states that behavioral health providers shall not be prohibited from collecting any portion of a deductible at the time of service. Goldberg says contracts that prohibit providers from collecting deductibles and co-payments at the time of service have caused confusion and frustration for consumers and providers and are “no longer necessary given the easy access to real-time information on deductible utilization.”

Seda Ebrahimi, Ph.D., director of the Cambridge Eating Disorder Center, says the bill’s most important element is that insurance companies must show cause when not renewing a contract.

“What makes the relationship between insurance companies and providers different from a standard business-to-business relationship is that there is a third party involved and that is the patient,” Ebrahimi says. “When an insurance company decides not to renew a contract without giving any reason, the patient ends up losing access to services from a provider they previously had. We all know how important the relationship between a patient and a provider is and how the potential risks to the patient and the community can be if access to mental health services becomes cumbersome and difficult to navigate.”

Eric Linzer, a spokesman for the Massachusetts Association of Health Plans, says the bill is unnecessary, and will unduly restrict the ability for plans to build a high-quality, cost-effective network with providers by setting unrealistic timeframes  with notifications. “The bill seems to be looking to create a solution where there doesn’t appear to be a problem,” Linzer says. “There are already provisions in state regulations around notification of changes in contracts between carriers and providers.”

Further, Linzer says data shows that less than one percent of providers are involuntarily terminated by a health plan and in instances where that occurs, it’s largely because of issues such as the provider has failed to meet recredentialing criteria or quality of care issues.

“There are legitimate reasons where a contract may be terminated,” Linzer says.

“If you look at objective data, it shows the plans are operating in good faith with mental health providers,” Linzer says. The proposed legislation is counterproductive at a time when the state is looking to reform the payment and delivery system and have a more integrated behavioral health system, he says.

By Pamela Berard

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