Press Release from Governor Tom Wolf’s Administration 

Governor Tom Wolf announced last week that the Insurance Department, in partnership with multiple state agencies, released a survey asking health care providers for input on their experiences with barriers to mental health and substance use disorder treatment.

Under the governor’s Reach Out PA: Your Mental Health Matters initiative, the Wolf Administration is undertaking a long-term, statewide campaign that seeks to educate and empower Pennsylvania providers and consumers about consumer rights under state and federal parity laws.

“The results from this survey will allow us to better inform and collaborate with providers, advocates and personnel on the front lines,” said Gov. Wolf. “Their experiences will help us enhance resources, develop more tools and create learning opportunities that will help serve the providers’ needs, which will ultimately help those in need of mental wellness services.”

For more than a decade, state and federal laws have required that treatment and services provided for mental health and substance use disorders must not have limitations that are stricter than those applied to medical/surgical treatments. Recent market conduct examinations of Pennsylvania insurers, however, have indicated that there are noncompliant barriers that are limiting consumers’ ability to access the treatment they need for mental health and substance use disorders.

“While complicated in its wording, both state and federal law are very clear that inequitable barriers to mental health and substance use disorder treatment will not be permitted,” said Insurance Commissioner Jessica Altman. “Through our market conduct examinations, we have found that many insurers have placed limitations on treatment that are stricter than state and federal parity requirements allow.”

The Wolf Administration is looking for feedback from mental health and substance use disorder providers, as well as other providers who have heard from patients that they have run into barriers when seeking treatment. The survey, developed by a working group of staff from the Insurance Department, and departments of Health (DOH), Human Services (DHS), Drug and Alcohol Programs (DDAP), State, Aging, the Office of the Attorney General and the Governor’s Office, will be sent to providers across the commonwealth.

The survey requests specific instances regarding complaints providers have heard from their patients about barriers to access. The survey also includes questions about providers’ experiences with barriers to treatment and problems with reimbursement for mental health and substance use disorder services. The aggregate data will be used to identify and address areas of concern by creating more accessible resources, included what is needed to help providers and other stakeholders learn more about parity.

“We often hear of struggles when providers seek authorization from insurers for substance use disorder treatment, particularly opioid use disorder treatment,” said DDAP Secretary Jennifer Smith. “We hope to get a better understanding of trends and how best to address them.”

“Providers typically have trusted relationships with their older adult patients that can be used to overcome stigma to seeking services and to help them gain access to mental health and substance abuse disorder treatments,” said Department of Aging Secretary Robert Torres. “We want all providers to have a knowledge base that empowers them to point their patients in the right direction.”

“The process for determining whether parity protections are being followed is incredibly detailed and requires data that is best identified by mental health and substance use disorder providers,” said DOH Secretary Rachel Levine. “Using the insights we gain from this survey, we will be able to give our providers better tools to empower their patients and clients.”

“Ensuring that mental health services are accessible to all Pennsylvanians is a critical step as we work to break down stigma and other barriers that keep people away from treatment,” said DHS Secretary Teresa Miller. “We need people to know that when they are ready to seek help, they will be met with support, not obstacles. This survey will help identify areas to improvement to ensure that people can access the help they need.”

The survey specific to providers will be sent directly to the e-mail addresses provided to the Department of State through the licensing process. The Insurance Department will be accepting survey responses through March 4, 2020. For more information about the survey, individuals can e-mail RA-IN-Parity-PID@pa.gov.

Since its introduction at the beginning of the year, Reach Out PA efforts have included a new consumer feedback form launched on January 23, and publication of a proposed regulation to enhance mental health parity reporting requirements for commercial health insurers. In just 10 days, more than 1,000 Pennsylvanians have completed the online form, offering input and suggestions, many of which detail challenges to accessing mental health services and pointing to potential parity violations.

Resources are available on agency websites, including information on substance use disorder and mental health coverage. More information and videos on parity can be found on insurance.pa.gov. These resources will be updated and expanded based on responses to the survey.