Hb 1013: Georgia Mental Health Parity Act

• Jurisdiction: Georgia,United States
• Citation: Vol. 39 No. 1
• Publication year: 2022
• topic: Civil Rights,Insurance Law,Criminal Law,Health Law

HB 1013: Georgia Mental Health Parity Act

Justin Crozier

jcrozier1@student.gsu.edu

Betsy Hicks

ehicks11@student.gsu.edu

Jordan Kalteux

jkalteux2@student.gsu.edu

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MENTAL HEALTH

Governing and Regulation of Mental Health: Amend Titles 15, 20, 31, 33, 37, 45, and 49 of the Official Code of Georgia Annotated, Relating to Courts, Education, Health, Insurance, Law Enforcement Officers and Agencies, Mental Health, Public Officers and Employees, and Social Services, Respectively, so as to Implement the Recommendations of the Georgia Behavioral Health Reform and Innovation Commission; Provide for Compliance with Federal Law Regarding Mental Health Parity; Provide for Definitions; Provide for Annual Reports; Provide for Annual Data Calls Regarding Mental Health Care Parity by Private Insurers; Provide for Information Repositories; Require Uniform Reports from Health Insurers Regarding Nonquantitative Treatment Limitations; Provide for Consumer Complaints; Provide for Same-Day Reimbursements; Provide for a Short Title; Provide for Definitions and Applicability of Certain Terms; Revise Provisions Relating to Independent Review Panels; Provide for Annual Parity Compliance Reviews Regarding Mental Health Care Parity by State Health Plans; Provide for Medical Loss Ratio; Revise Provisions Relating to Coverage of Treatment of Mental Health or Substance Use Disorders by Individual and Group Accident and Sickness Policies or Contracts; Define Medical Necessity for Purposes of Appeals by Medicaid Members Relating to Mental Health Services and Treatments; Provide for a State Medicaid Plan Amendment or Waiver Request if Necessary; Provide that No Existing Contracts Shall be Impaired; Provide for Service Cancelable Loans for Mental Health and Substance Use Professionals; Provide for the Establishment of a Behavioral Health Care Workforce Data Base by the Georgia Board of Health Care Workforce; Provide for a Grant Program to Establish Assisted Outpatient Treatment Programs; Provide for Definitions; Provide for Grant Requirements; Provide for Grant Application and Award; Provide for Research and Reporting; Provide for Rules and Regulations; Revise Definitions Relating to Examination and Treatment for Persons who are Mentally Ill or who have Addictive Diseases; Authorize Peace Officers to Take Persons to Emergency Receiving

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Facilities Under Certain Circumstances; Provide for a Grant Program for Accountability Courts that Serve the Mental Health and Substance Use Disorder Population; Provide for Powers and Duties of the Office of Health Strategy and Coordination; Provide for Methods to Increase Access to Certified Peer Specialists in Rural and Underserved or Unserved Communities; Provide for Implementing Certain Federal Requirements Regarding the Juvenile Justice System; Provide for Automatic Repeal; Provide for Funds from the County Drug Abuse Treatment and Education Fund for Mental Health Divisions; Provide for Training Requirements for Behavioral Health Co-Responders; Provide for Co-Responder Programs; Provide for Continued Exploration of Strategies for Individuals with Mental Illnesses; Authorize the Behavioral Health Reform and Innovation Commission to Collaborate and Provide Advisement on Certain Programs, Coordinate Certain Initiatives, and Convene Certain Groups and Advisory Committees; Extend the Sunset Date for the Behavioral Health Reform and Innovation Commission; Provide for an Annual Report by the Administrator of the Georgia Data Analytic Center Relating to Complaints Filed for Suspected Violations of Mental Health Parity Laws; Provide Coverage for Medications for the Treatment of Certain Disorders Under Medicaid; Provide for Related Matters; Repeal Conflicting Laws; and for Other Purposes

Code Sections: O.C.G.A. §§ 15-1-23 (new); 15-21-101 (amended); 20-3-374 (amended); 31-2-17 (new); 31-53-3 (amended); 33-1-27 (new); 33-20A-31 (amended); 33-21A-13, -14 (new); 33-24-28.1, -29, -29.1 (amended); 35-5-2, -5 (amended); 35-6A-15 (new); 37-1-7, -20, -114.1, -115.1 (new), -116 (amended), -120, -121, -122, -123, -124, -125 (new); 37-2-4, -6 (amended); 37-3-1, -42, -101 (amended); 37-7-1, -42, -101 (amended); 45-12-154.1 (new); 49-4-152.6

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(new), -153 (amended); 49-5-24 (amended); 49-10-5 (new)

Bill Number: HB 1013

Act Number: 587

Georgia Laws: 2022 Ga. Laws 26

Summary: The Act overhauls Georgia's mental health system by enforcing compliance with federal mental health parity law. Most notably, the Act requires health insurers to provide coverage for mental health and substance use disorders equitably with physical health and defines generally accepted standards of care. The Act requires insurers to submit annual parity compliance reports and requires the commissioner to make annual data calls and submit annual reports. The Act requires compliance with a minimum 85% medical loss ratio. The Act provides for cancelable loans to Georgia residents enrolled in related educational programs and creates grant programs for accountability courts. The Act conditionally authorizes peace officers to involuntarily commit persons to emergency receiving facilities. Finally, the Act creates a multi-agency treatment for children team (MATCH) to facilitate collaboration across state agencies.

Effective Date: July 1, 2022

History

While Georgia ranks as the number one state for business, it ranks last for access to mental health care.¹ Access to mental health care is

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measured by "access to insurance, access to treatment, quality and cost of insurance, access to special education, and mental health workforce availability."² Congress tackled this issue in 2008 by passing the Mental Health Parity and Addiction Equity Act (MHPAEA).³ The MHPAEA, and mental health parity in general, requires health care providers to impose the same benefit limitations for mental health or substance use disorder treatment as for medical or surgical treatment.⁴ Although the MHPAEA has been in place since 2008, it took the Georgia legislature fourteen years to enforce parity compliance.⁵

In 2019, the Georgia House of Representatives passed legislation creating the Behavioral Health Reform and Innovation Commission (the Commission).⁶ The Commission is comprised of twenty-four members appointed by the Governor, the Lieutenant Governor, the speaker of the House of Representatives, and the Chief Justice of the Georgia Supreme Court.⁷ In January 2021, the Commission produced its First Year Report (the Report) on its "comprehensive review of the behavioral health system of care in Georgia."⁸ While the Report covered several topics, "[p]arity in insurance coverage for behavioral health treatment, including substance use disorders, [was] central to all

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the issues . . . considered by the [C]ommission."⁹ The Commission recommended creating a "working group" of various departments to research other states and consider what legislation Georgia needed for mental health parity.¹⁰ The Commission also recommended that the Georgia Department of Community Health and the Georgia Department of Insurance create annual reports to monitor compliance.¹¹ Lastly, the Commission recommended a streamlined process for filing complaints and tracking parity violations.¹² The Georgia legislature used the Commission's recommendations to draft House Bill (HB) 1013, the Mental Health Parity Act, bringing Georgia in line with the MHPAEA by providing for mental health parity in the state.¹³

Representative Mary Margaret Oliver (D-82nd), a Commission member, and Representative Todd Jones (R-25th) sponsored the bill in the House.¹⁴ Representative Jones's wife, Tracy Jones, spoke at Committee meetings about the importance of mental health parity in combating mental health and substance use in Georgia.¹⁵ The Joneses' oldest son, Justin, has schizoaffective disorder, suffers from substance use disorders, and has struggled with drug abuse throughout his life causing him to be admitted to substance use and mental health facilities more than thirty times.¹⁶ Because of the lack of mental health parity in Georgia, Justin's insurance severely limited his ability to improve his mental health and receive appropriate treatment.¹⁷ His healthcare providers focused on "acute symptoms" and short-term improvement rather than long-term stability and relapse prevention.¹⁸ As a result,

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Georgians like Justin struggled to get the treatment they deserved. Justin is one of over 300,000 Georgians suffering from "serious mental illness" and one of over 500,000 Georgians over the age of twelve suffering from substance use disorders.¹⁹ Justin's story exemplifies why HB 1013 was necessary.

Before the Mental Health Parity Act, insurance providers were reluctant, or simply refused, to cover treatment for chronic mental health and substance use disorders.²⁰ Insurers would push a diagnosis of drug-induced hallucinations rather than chronic disorders because it was cheaper to treat.²¹ In several situations, "patients would have to be suicidal before the insurance company ha[d] to pay for a visit."²² Because of the Act, "families will no longer have to pay out of pocket for needed care due to arbitrary coverage limits and denials."²³

Although HB 1013 enjoyed strong bipartisan support, portions of it were amended.²⁴ Opponents criticized the involuntary patient provision that allowed peace officers to use a lower standard to involuntarily commit individuals suffering from mental health or substance use disorder episodes.²⁵ Before HB 1013, officers could

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initiate a 1013 hold if they witnessed someone they believed to have mental health issues committing a crime or in imminent risk of harm to themselves or others.²⁶ Once the hold was initiated, the patient would be detained for up to forty-eight hours while waiting for a mental health evaluation to determine if the person needed to be involuntarily committed for inpatient or outpatient treatment.²⁷ Because police officers...