July 18, 2022
OLYMPIA, Wash. – A new law expanding consumers’ protections from surprise medical bills also adds new protections for patients seeking care for a behavioral health or substance use disorder emergency. Insurance Commissioner Mike Kreidler recently urged other state regulators to take similar actions.
“We have a behavioral health crisis in our country, and even with strong mental health parity laws, we know that people may not get the coverage they’re entitled to,” said Kreidler. “We know that critical behavioral health emergency care is being delivered by providers and crisis teams outside a hospital setting. These patients deserve the same level of protections as patients experiencing a medical emergency.”
In Washington state and nationally, health insurers must cover emergency services even if the provider or facility is out-of-network, and they cannot require a prior approval if a patient reasonably believes they have a medical emergency.
Previously, emergency services were only covered if delivered in a hospital setting. Hospital emergency rooms often lack the staff and capacity to address behavioral health emergencies, but there are providers designed and licensed for this purpose. The new law expands the definition of emergency providers and facilities to include behavioral health emergency providers, such as crisis stabilization units, evaluation and treatment facilities, and mobile rapid response crisis teams.
Before the federal No Surprises Act, emergency care included just screening, examination and services needed to stabilize a person’s emergency condition. The new federal law adds post-stabilization services such as outpatient observation to the definition of emergency services. The new law in Washington state extends coverage of post-stabilization services to people receiving care from a behavioral health emergency services provider as well.
"I applaud Washington state for taking the steps necessary to hold health insurers accountable for equal coverage of mental health and addiction treatment services,” said former U.S. Rep. and founder of The Kennedy Forum, Patrick J. Kennedy. "People everywhere are in desperate need of better access to care — other states and the federal government must now follow suit to ensure parity in emergency services.”
Washington state’s Balance Billing Protection Act protects patients from getting a surprise medical bill when they seek emergency services from any emergency provider or facility or if get care from an out-of-network provider at an in-network hospital or ambulatory surgery center. This law was updated earlier this year to add the benefits included in the recent federal No Surprises Act and to include surprise billing protections for a wider scope of emergency care providers and facilities, as well as air ambulance services.
"The expansion of surprise billing to include all the facilities who respond to behavioral health emergencies is critical in addressing behavioral health parity and is a significant step towards racial and socio-economic equity in coverage,” said Lauren Simonds, Executive Director of NAMIWA.org.
“Every Washingtonian owes these legislators thanks for their leadership in helping pass these reforms: Rep. Eileen Cody,D-Seattle and Rep. Joe Schmick, R-Colfax and Sen. Annette Cleveland, D-Vancouver," added Kreidler. “We could not have accomplished these changes without their bipartisan leadership and support.”