Project overview
The Office of the Insurance Commissioner (OIC) received two federal grants to see if state-regulated health insurers are offering comprehensive and affordable access to mental health services and treatment for substance use disorders. The OIC is examining health insurers' benefit designs, policies and procedures, and claims data related to accessing mental health and substance use disorder treatment services, including alternatives to opioids for treating pain.
A 25-member advisory committee including consumer advocates, behavioral health and medical providers, and health insurers helps guide the project.
The project started in 2018 and we are currently in the second of two cycles:
Cycle II (Ongoing)
OIC received additional federal funding to update and improve educational materials for consumers and behavioral health providers on their rights to access behavioral health services and how to appeal denials of requests for services. In addition, we will conduct a detailed claims analysis to understand trends in access to mental health and substance use disorder treatment services.
Cycle II includes five projects:
- Pursue market conduct activities related to health insurers’ responses to previous market scans. The OIC has hired a market conduct consultant/examiner and a contractor with expertise in behavioral health parity. This work is currently in progress.
- Refine the market scan documents and other materials the OIC uses to gather information and review parity compliance. This work is currently in progress.
- Improve OIC’s ability to assist consumers in understanding their rights under state and federal assistance with behavioral health parity laws, including how to use the Federal Department of Labor’s Consumer Parity Disclosure form (PDF, 179 KB). Also, improve our web content and create consumer and provider education materials. This work is complete.
- Create legislative or rulemaking proposals to address issues found in Cycle I. This work is in progress.
- Use the Washington state All Payer Claims Database to analyze recent claims data and compare it to past data to see if OIC’s parity compliance work has improved access to behavioral services. The study is currently in progress and targeted for fall 2023. This work is complete.
Cycle I (Aug. 2018 - July 2020)
OIC issued two market scans to identify any barriers to mental health and substance use disorder d services as well as services for pain treatment.
The University of Washington's Department of Psychiatry and Behavioral Sciences was contracted to help review the responses from the first market scan and produce recommendations. Its report informed the focus areas for the second market scan.
The OIC also hired OnPoint to study how people in commercial health plans use behavioral health services. The claims data used is from Oct.1, 2017 – Sept. 30, 2018. This data set included both paid and denied claims for all medical and behavioral services, including substance use disorder treatment services. This "merged" claims data set combined information from the All Payer Claims Database (APCD) with additional data obtained from carriers offering health plans in Washington state