Mental health service cost and use trends

To help policymakers and interested parties better understand how consumers use mental health services and the cost of those services, our office contracted with Onpoint Health Data to create a searchable dashboard of behavioral health-specific claims. 

The data is from the Washington All Payer Claims Database (WA-APCD) and includes claims between 2017-2022 for all state-regulated health plans and Washington’s Public and School Employee Health Benefit Programs (PEBB/SEBB).  

The information in the dashboard will be available to policy experts, legislators and others to get a better understanding of how mental health care services are accessed across Washington state and to propose solutions that improve access and coverage for these critical services. 

Anyone can use the dashboard to find:

  • How often consumers sought treatment for various mental health conditions.
  • The types of services used. 
  • How often out-of-network providers were used and how that varied across the state.
  • How much insurers paid providers for these services.

Key findings include:

  • From 2017-2022, the percentage of insurance claims involving a mental health diagnosis increased from 11.83% to 17.43%. 
  • In 2022, 18% of enrollees in an urban area had a mental health diagnosis compared to 13.55% in rural areas. 
  • In 2022, 7.6% of mental health services were provided by out-of-network providers compared to 4.2% of other medical services. 
  • The cost of mental health services has increased 69% since 2017, driven primarily by the use of services. During the same time, the average amount paid to providers per service has only increased by 4%. 

How to use the dashboard

You can do four types of searches:

  • Cost Driver - Search by the type of mental or medical health service for all health plan enrollees, enrollees with any mental health illness or enrollees with a serious mental health condition.  
  • Conditions Overview - Search by year, mental health condition and diagnosis for various measurements including outpatient facility rate, hospital emergency department visit rate, pharmacy claims and more.  
  • Geographical Overview – Search mental health conditions and diagnosis by region for various services, such as rates of pharmacy claims, primary care visits and inpatient admission rates.
  • Network Analysis – See the types of claims by year and region that were provided either by network or out of network providers.

Example: Find out what’s driving the cost of psychotherapy counseling.

Steps: 

  1. Select the “Cost Drivers” tab.
  2. Select “Psychotherapy/Counseling” from the “Service Type” dropdown menu.
  3. Select “All Members” from the “Member Population” dropdown menu.

Results:

According to the data, use, not price, drove the per member per month increase:

  • Per member per month (PMPM) cost increased 112%.
  • Use per 1,000 members increased by 94%.
  • The average price per service increased by 9%.

Project funding

This project was supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $684,447 with 100% funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government. 

Wildfire Symposium

The OIC's 2023 Wildfire Symposium, part of the Climate Summit Series, highlights the issues the threat of wildfires has on the insurance market in Washington state. What is the risk to consumers? How can we work together to mitigate that risk? Is there a chance home insurers pull out of the market and leave rural residents without any options? 

This series of short presentations and conversations was recorded in November of 2023. Guests and presenters include:  

  • Program managers from the Washington State Department of Natural Resources. 
  • Representatives from Verisk Analytics, a leading risk assessment firm. 
  • The executive director of the Okanogan County Long-Term Recovery Group. 
  • The vice president of the Reinsurance Association of America. 

Note: The Climate Summit Series also featured a presentation from from the Insurance Institute for Business and Home Safety (ibhs.org). IBHS President & CEO Roy Wright discusses the "why" behind wildfire losses and what the IBHS has learned (youtube.com), through its research facility, about how wildfires behave and what homeowners can do to prepare for wildfires and mitigate losses.

Engaging Communities in Wildfire Preparedness 

Guy Giffords from the Washington State Department of Natural Resources’ Community Resilience Program discusses the program, its outreach, and its reception.  

Long-Term Recovery for Communities After Wildfire Loss 

Carlene Anders, the Executive Director of the Okanogan County Long Term Recovery Group, the mayor of Pateros, and a former firefighter with the Department of Natural Resources and the U.S. Forest Service, discusses wildfire mitigation and resiliency after a major fire event. 

An Introduction to Reinsurance with Dennis Burke 

Dennis Burke, the Vice President of State Relations for the Reinsurance Association of America, provides an introduction to reinsurance. Burke touches on the role of reinsurers, the impact of global property catastrophes, catastrophe bonds, and what the future could hold for the reinsurance market. 

Risk Scoring Tools with Verisk

Roger Grenier and JulieAnna Anastassatos, from Verisk Analytics, discuss the factors at work in their risk scoring tools and how governments and homeowners can improve their risk score.

Requirements for insurers premium change transparency rule

Types of policies impacted

The affected insurance policies are:

  • Private passenger auto policies (this does not include policies that cover boats, motorcycles, off-road vehicles, recreational vehicles, antique or collector vehicles, classic vehicles, and specialty vehicles) (WAC 284-30A-020(2)(a), (4)(a)); and
  • Homeowner’s policies (including mobile and manufactured homeowners, condominium owners and renter's coverage) (WAC 284-30A-020(2)(b)).

The new rules do not apply to surplus lines, commercial auto policies, health plans, life, disability, and long-term care policies, and personal umbrella policies. (WAC 284-30A-020(4)(b, f)).

Phase 1 - June 1, 2024

Premium increase notices

Insurers are required to inform policyholders that they can request more details about their premium increase by contacting their insurer. (WAC 284-30A050(2), (5)). Disclaimer requirements include:

  • Located on the first page or view of renewal notices and renewal billing statements.
  • Bold font with a minimum size of 12 points.
  • Statement with similar language - "Policyholders receiving an increase to their premiums at renewal can request an explanation by contacting their insurer in writing. Please see Chapter 284-30A WAC for additional information on your right to an explanation for your rate increase." (WAC 284-30A-050(1)).
  • Insurer contact information.

Explanation of premium increases

Insurers must provide a reasonable explanation for premium increases when policyholders request, in writing, information about a premium increase that occurred at renewal. (WAC 284-30A) Reasonable explanation requirements include:

Insurers are not required to but may include the policyholder’s producer’s contact information in all premium change notices and explanations. (WAC 284-30A050(2)).

Phase 2 - June 1, 2027

Notices and explanations to consumers

Insurers must provide notice of premium changes at least 20 days before renewing a policy with a 10% or greater increase. (WAC 284-30A-050(4)(b)). They must also provide notice within 20 days of a written request from the policyholder (WAC 284-30A-050(4)(a)).

Insurers are required to give policyholders clear explanations for any premium increases and include the primary factors that caused the increase in premium change notices, as mandated by WAC 284-30A-040(2).

The primary factors must always be included in premium change notices when applicable:

  • Car garaging location, driving record, miles driven, number of drivers, number of vehicles, claims history, discounts, fees and surcharges, age, credit history, education, gender, marital status, occupation, property age, property location, property value, premium capping, and rate changes (including that subject to rate stability rules, transition rules, or premium-capping rules). (WAC 284-30A-070(2)(a)).

Premium change notice templates

The OIC has provided a standard premium change notice template for insurers to use, but they may also create their own version if it meets the requirements described in (WAC 284-30A-060(1)).

Filing requirements

Insurers must file their premium change notice forms with the OIC starting January 1, 2027, through the System for Electronic Rate and Form Filings (SERFF). (WAC 284-30A-060(3)).

Requirements for both Phase 1 and 2

  • A policyholder can request more information after a premium increase explanation. Insurers must respond within 20 calendar days. (WAC 284-30A-050(6)).
  • Insurers can include estimated amounts in the notices if they also explain the accuracy of the estimate for the policy and premium increase. (WAC 284-30A-070(4)).
  • Insurers can use composite rating factors but must specify the premium increase caused by them. (WAC 284-30A-070(3)).
  • Insurers can choose to provide an explanation for the entire premium increase. (WAC 284-30A-070(6); WAC 284-30A-080).
  • Insurers must keep accessible records of premium increase explanations under RCW 48.05.280. (WAC 284-30A-050(10)).
  • Insurers are not obligated to disclose usage-based insurance data, credit-based insurance scoring models, company placement criteria, or trade secrets. (WAC 284-30A-020(4)(c-d)).
  • Violations of Chapter 284-30A WAC constitute unfair trade practices and may result in penalties and remedies. Chapter 48.30 RCW and Chapter 284-30 WAC. (WAC 284-30A-90(1)).

Essential health benefits benchmark plan

We were required to report our findings and decision to the legislature by Dec. 31, 2023.

Defining Washington state’s EHB-benchmark health plan 

The Affordable Care Act requires certain benefits, items and services be covered by all individual and small employer health plans. These are called Essential Health Benefits. Each state must select its own “benchmark” health insurance plan and use it to determine its essential health benefits. Since 2020, Washington state’s EHB benchmark plan has been the Regence BlueShield Direct Gold+ small group health plan.

Beginning in 2020, the Centers for Medicare and Medicaid Services (CMS) gives states three options to define their EHB benchmark plan:

  • Option 1: Select another state’s entire EHB benchmark,  
  • Option 2: Replace a category of benefits in the current benchmark with the same category of benefits used in another state's EHB plan, or  
  • Option 3: Select a set of benefits to become part of your state's EHB plan. 

States that want to make changes are required by federal law to have an actuarial analysis of the benefits, a public comment on the proposed changes, and to apply to CMS.

New EHB benchmark plan implementation

Opportunity for public comment on the State's selection of an EHB-benchmark plan, per 45 CFR 156.111

2023 essential health benefits report and presentation

How to get involved

Public comments

Past meetings

Dec. 13, 2023

Oct. 20, 2023

Sept. 12, 2023 

June 12, 2023 

State and federal EHB information 

Washington state:

Federal:

Getting your health plan to cover your prescription drug

Under state law, this process prevents your insurer from using other ways to limit drug coverage, such as prior authorization, step therapy or “fail first” policies.

How to ask your health plan to cover a prescription

You can ask your health insurer to cover a prescription drug they don't cover or that your provider prescribed as “off-label.”

Once you or your provider request this:

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