- Report Published -
|Insurance Coverage for Persons with Mental Disabilities|
|Insurance Task Force|
|HJR 319 (1989)|
|In May 1989, as requested by House Joint Resolution (HJR) 319, Howard M. Cullum, Commissioner, Department of Mental Health, Mental Retardation and Substance Abuse Services, and Steven T. Foster, Commissioner, Bureau of Insurance, State Corporation Commission, convened a Task Force composed of service providers, the insurance industry, advocates for individuals with mental disabilities, and university teaching hospital representatives. Jointly they appointed Isabel Brenner, a member of the State Mental Health, Mental Retardation and Substance Abuse Services Board, as Chairman of the newly-formed Insurance Task Force. The Task Force held its first meeting in June 1989 and met monthly since then.|
As part of HJR 319, the Task Force was charged with coordinating its study with Senate Joint Resolution (SJR) 169 Joint Subcommittee Studying Mandated Substance Abuse Treatment and Prevention Programs. The Joint Subcommittee worked with a Substance Abuse Insurance Task Force comprising agency and industry representatives. This task force studied ways to provide adequate insurance coverage for substance abuse services. In addition, SJR 191, 1989, established a Joint Subcommittee to study certain practice among psychiatric professionals and institutions. These study committees reviewed similar issues. Tow Task Force members sat on these other legislative study groups and apprised the Task Force of their activities and status.
Deborah Hallar, Ph.D., Chairman of the Substance Abuse Insurance Task Force, presented the Task Force with the status of her group's progress and preliminary recommendations. It was clear that many of the issues were the same or similar to those discussed by the Insurance Task Force and that it would be important, if possible, to coordinate activities of this Task Force with those of the Substance Abuse Insurance Task Force. The Substance Abuse Insurance Task Force submitted a report in November 1989, continued to meet, and submitted a final report recommending a three tier system with conversion ratios of 1:6 inpatient days to outpatient visits and 1:3 inpatient days to day support/intensive outpatient, and outpatient visits. to test its recommendation, the SJR 23 subcommittee recommended that a pilot project be designed using community services board sites and the Medicaid charging system.
By action of the 1990 General Assembly, HJR 42 extended the Insurance Task Force study for another year to allow sufficient time to review the report of the Substance Abuse Insurance Task force and to analyze the information to be collected in the benefits survey to be conducted by the Bureau of Insurance.
After reviewing the SJR 191 recommendations, the Task Force proceeded to develop recommendations. Foremost in the group's discussion was the concept of a conversion method that would allow the trade off of the mandated 30 day inpatient hospitalization for alternative and more appropriate partial hospitalization or outpatient care. Interested in greater flexibility and cost neutrality, the Task Force looked at ratios for substituting inpatient treatment with partial hospitalization and outpatient services and came to an impasse.
Several studies were cited about the relative value of trading inpatient care for less costly and sometimes more effective alternative psychiatric treatment. Clinical studies claim cost savings for early intervention which reduced the duration of the more costly inpatient treatment. Insurance industry studies claim that when outpatient benefits are offered, rather than having improved flexibility, a new market is tapped with large numbers of new consumers seeking services so that overall cost is for greater.
Task Force members recommended that an independent, third party provide objective assistance with examining the "conversion" concept and recommending alternative methods or formulae for providing flexibility with cost neutrality. The Task Force received the study findings and selected two options for additional examination and financial analysis. Members wee concerned that the legislative recommendations be efficacious and withstand the close scrutiny of General Assembly members.
Because Virginia has been cited as a national leader in mental health and the Task Force is representative of all the forces interested in this issue, the National Institute of Mental Health provided grant monies to partially underwrite the cost of a study by health care economists. A select committee of the Task Force interviewed health care economists and recommended the selection of a team if researchers from the Johns Hopkins University School of Hygiene and Public Health and Boston University. The Task Force awarded them the contract to examine the conversion concept and alternatives by providing econometric analyses of variations of the conversion as well as alternative formulae.
Stephen Ayres, M.D., Dean of the Medical College of Virginia offered to assist the Task Force by reacting to the Johns Hopkins' report and assured that its findings and recommendations were within the context of Virginia's health delivery system. He expressed an interest in having a small group explored the provider side of the mental health care equation with a view toward the development of standards and provider incentives.
The Task Force discussed the findings, formulated positions, and prepared recommendations for consideration by the Governor and the General Assembly. Acting to achieve more flexible treatment choices within the constraint of maintaining premium cost neutrality, the Task Force recommended by vote that the 30 day inpatient mandate be converted to allow up to 20 days inpatient with a 20% co-payment, $1,000 of outpatient visits with a 50% co-payment, and a 2 for 1 substitution of inpatient days for partial hospitalization. Five Task Force members supported a conversion option of 20 days inpatient and a 2 for 1 conversion of inpatient days to partial hospitalization which would allow up to 40 days of partial hospitalization.
Further the Task force recommended that the General Assembly work toward the ideal by considering the issues of parity coverage for mental health and substance abuse treatment, adequacy of funding to support treatment, and increasing the insurance mandated to include outpatient treatment.