Magazine article Behavioral Healthcare Executive

Proposed Policy Could Eliminate Insurance Denials

Magazine article Behavioral Healthcare Executive

Proposed Policy Could Eliminate Insurance Denials

Article excerpt

Providers in New Jersey are optimistic about state senate bill S2180, which would no longer allow managed care organizations to apply utilization management to behavioral healthcare services. It's an extreme measure. If passed, it would be the first statute to require insurers to cover treatment without prior approval or fail-first protocols.

In other words, if a licensed provider orders five weeks of residential treatment, for example, the patient's insurance company would automatically be obligated to cover it.

As might be expected, the proposal has promise, but there could be far more aspects working against it. The bill is broad, which tends to be troublesome in policymaking, and right now, it doesn't have any cost-saving offsets, which could ultimately prevent S2180 from progressing any further.

But the proposed policy is in the early phases, so all these hurdles can potentially be addressed in future iterations.

What advocates might have going for them now is strong bipartisan support in New Jersey for solutions with the potential to tackle the state's growing opioid epidemic. Governor Chris Christie, a Republican, has been supportive of the recovery community and has indicated he wants to see an increase in the number of treatment beds in the state.

New Jersey has a Democratcontrolled state legislature, and the political will to make improvements in behavioral health access could be there as well. Lawmakers are increasingly hearing concerns from constituents whose loved ones are dying from substance use disorders at an alarming rate. Heroin and opioid overdoses claimed the lives of 750 people in New Jersey last year.

Bill S2180 recently passed the New Jersey Senate Commerce Committee with a vote of 4-to-2 and has now moved on to a budget committee that must attach savings numbers to the proposal.

Stakeholder feedback

Seabrook House Vice President of Business Operations Matthew Wolf, who attended the Commerce Committee hearing on S2180, says the entire debate was dominated by the discussion of cost. Wolf says he was struck by testimony from stakeholders in the healthcare industry who highlighted the price of treatment rather than the fact that patients are dying because they aren't getting the help they need to recover from addiction. …

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