A cornerstone of this reform is the idea that a person’s mental health is just as important as a person’s physical health. This bill codifies this principle by mandating coverage for an annual mental health wellness exam, comparable to an annual physical. 

This bill provides the state with better tools to implement and enforce parity laws by creating a clear structure for the Division of Insurance to receive and investigate parity complaints and ensure their timely resolution. Other tools include parity enforcement for commercial, state-contracted and student health insurance plans, increased reporting and oversight of insurance carriers’ mental health care coverage processes and policies, and reasonable penalties and alternative remedies for when an insurance company does not comply with the law. 

For many people with acute mental health needs, the only place to get help is an emergency department (ED). Unfortunately, these patients may wait days, weeks, and even months for more appropriate admission to an inpatient psychiatric unit or less acute level of care. This is referred to as ‘boarding,’ which continues to rise dramatically. This legislation tackles this by creating online portals that provide access to real-time data on youth and adults seeking mental health and substance use services and includes a search function that allows health care providers to easily search and find open beds using several criteria; requiring the Health Policy Commission (HPC) to prepare and publish a report every three years on the status of pediatric behavioral health as the youth boarding crisis is particularly acute; requiring the Center for Health Information and Analysis (CHIA) to report on behavioral health needs; updating the expedited psychiatric inpatient admissions (EPIA) protocol and creating an expedited evaluation and stabilization process for patients under 18; codifying in statute the working group tasked with implementing the EPIA in law. 

This bill mandates coverage and eliminates prior authorization for mental health acute treatment and stabilization services for adults and children. It also establishes a special commission to bring all stakeholders to the table to study and make recommendations on the creation of a common set of medical necessity criteria to be used by health care providers and insurance carriers for mental health services.