SENATE CONCURRENT RESOLUTION 76

(By Senators Takubo, Stollings, Baldwin, and Unger)

[Introduced April 9, 2021]

Requesting the Joint Committee on Government and Finance study mental health parity in the State of West Virginia.

Whereas, Mental health parity is complicated and difficult to ascertain even among mental health providers and insurers; and

Whereas, On one hand, providers of mental health services believe that these services are not being reimbursed or delivered on par with physical health services; yet, insurance companies believe that medical necessity criteria and their own internal standards should dictate the level of care; and

Whereas, To determine whether or not these services are being properly reimbursed or delivered, data must be produced by the insurance company; and

Whereas, Federal mental health parity laws require that limitations on mental health and addiction treatment be no greater than those for medical or surgical benefits; and

Whereas, Recently a federal court concluded in Wit. V. United Healthcare that the health insurer “breached its fiduciary duty by violating its duty of loyalty, its duty of care, and its duty to comply with plan terms by adopting Guidelines that [were] unreasonable and [did] not reflect generally accepted standards of care” for both residential mental health treatment and intensive outpatient mental health treatment. The court further states that insureds were harmed by being denied their right to fair adjudication of their claims for coverage based on guidelines that were developed solely for the insurer’s benefit. Furthermore, the court found “by a preponderance of the evidence, that [the insurer’s] guidelines were unreasonable and an abuse of discretion because they were more restrictive than generally accepted standards of care.”; and

Whereas, Mental health care providers experience burdensome utilization review paperwork and overly frequent reviews; and

Whereas, Managed care organizations are not following American Society of Addiction Medicine’s criteria for addiction treatment; and

Whereas, Timeliness of prior authorization denials for mental health care treatment by managed care organizations are resulting in loss of revenue for providers; and

Whereas, There are many inconsistencies between managed care organizations for mental health treatment guidelines which make consistent treatment difficult; and

Whereas, West Virginia is facing an ongoing opioid addiction epidemic, which harms not only affected citizens, but their families and communities; and

Whereas, Mental health initiatives are becoming increasingly important across the country as mental health diagnoses have risen; therefore, be it

Resolved by the Legislature of West Virginia:

That the Joint Committee on Government and Finance study mental health parity in the State of West Virginia; and, be it

Further Resolved, That the study include analysis of guidelines used by managed plan organizations and health insurers in the state as applied to nonquantitative treatment limitations for benefits for behavioral health, mental health, and substance use disorders; and, be it

Further Resolved, That the Joint Committee on Government and Finance report to the regular session of the Legislature, 2022, on its findings, conclusions, and recommendations, together with drafts of any legislation or resolutions necessary to effectuate its recommendations; and, be it

Further Resolved, That the expenses necessary to conduct this study, to prepare a report, and to draft necessary legislation be paid from the legislative appropriations to the Joint Committee on Government and Finance.