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PARITY IN REIMBURSEMENT for behavioral health services

(House Bill 8157)


THE PROBLEM: Rhode Island health insurers pay mental health professionals 23.4% less than they do physical health providers. This disparity means many mental health professionals cannot afford to join insurance networks. Mental health providers and agencies have documented that insurer reimbursement is often lower than the cost of delivering care, forcing some to close their doors. This problem contributes to a lack of available providers for those of us seeking help.


ONE SOLUTION: House Bill 8157 takes a reasonable, responsible, stepped approach to increasing reimbursement rates paid for behavioral health services by commercial payers to bring payment for mental health services more in line with physical health services. The bill addresses stagnant reimbursement rates using a formula based on the Consumer Price Index.


MORE ABOUT WHY THIS LEGISLATION IS IMPORTANT:


● Paying behavioral health providers less than their counterparts on the medical side of an insurance plan discourages them from participating in insurance networks. This results in an insufficient behavioral health network, and that is a violation of mental health parity laws.

● Rhode Island has a shortage of in-network providers, from therapists and counselors to psychologists and psychiatrists, due in part to the low reimbursement rates these professionals are paid.

● The need for more mental health professionals is reaching a crisis level. The COVID-19 pandemic has caused an increase in depression, anxiety and substance use. Now that the pandemic is subsiding and public life is opening up again, there is even more of a surge in people seeking mental/behavioral health services. Our current workforce cannot meet the demand.

● People of Color and immigrants have difficulty finding a provider who looks like them and shares their culture and/or language. Compensating for behavioral health services, helps incentivize more people to enter the profession, including people of color.

● Consumers have to go on long waitlists to see providers with certain areas of expertise.

● Consumers have to make call after call after call to find in-network providers who are taking new patients.

● Insurers offer “ghost networks” of providers who are licensed but not necessarily in that plan’s network; are no longer taking new clients; are booking several months out for appointments; only see patients discharged from certain affiliated hospitals; or are not even practicing anymore.

● Providers have not had a rate increase in a number of years while the cost of doing business has increased forcing providers to struggle to pay their bills; some are taking on loans, and others are at risk of going out of business

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