2023 -- H 6524

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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H O U S E   R E S O L U T I O N

RESPECTFULLY REQUESTING THE OFFICE OF THE HEALTH INSURANCE

COMMISSIONER TO STUDY, PUBLICLY REPORT DATA ON, AND PROVIDE

RECOMMENDATIONS FOR, ADDRESSING THE CRITICAL INADEQUACY OF ACCESS

TO BEHAVIORAL HEALTH SERVICES IN RHODE ISLAND'S COMMERCIAL

INSURANCE NETWORKS

     Introduced By: Representatives Tanzi, Chippendale, Blazejewski, Felix, Cruz, Potter,
Giraldo, Stewart, Alzate, and Boylan

     Date Introduced: June 14, 2023

     Referred To: House read and passed

     WHEREAS, The United States of America is battling a collective behavioral health crisis

and, according to the National Survey on Drug Use and Health (NSDUH), 25.85 percent of

Rhode Island adults who are 18+, reported experiencing a mental health illness of some kind

(AMI) in 2022; and

     WHEREAS, According to the 2022 Rhode Island Health Insurance Survey (HSRI), the

number of people reporting a delay in accessing mental health care or care not received due to

"insurance not accepted" increased from 3.9 percent in 2020, to 4.3 percent in 2022; and

     WHEREAS, According to the 2022 Rhode Island Health Insurance Survey (HSRI), the

number of people reporting a delay in mental health care or in care not received due to "no

provider available" jumped from 5.2 percent in 2020 to 8.2 percent in 2022; and

     WHEREAS, According to the 2022 Rhode Island Health Insurance Survey (HSRI), those

who pay more than $250 out-of-pocket for mental health care have increased every year since

2015; and

     WHEREAS, According to the 2021 National Survey on Drug Use and Health estimates,

Rhode Island has consistently exceeded the estimated United States prevalence for both Any

Mental Illness (AMI) and Serious Mental Illness (SMI) over the past decade; and

     WHEREAS, A review of RI insurance claims revealed that between 2016 and 2020, the

second-most frequently accessed setting for AMI-related care was the emergency room. Although

emergency room utilization related to AMI was significantly less than general outpatient, it

predominated over inpatient care, partial hospitalization programs, and intensive outpatient

programs; and

     WHEREAS, According to data drawn from RI insurance claims, a high percentage of

care related to Any Mental Illness (AMI) and Substance Use Disorders (SUD), occurs at the

emergency room. Between 2016 and 2020, more than half of those who had been discharged

from the emergency room (ER) for AMI-related or SUD-related care were readmitted to the ER

after less than a year prior. This startlingly high rate of readmission emphasizes the crucial

importance of preventing initial emergency room admission; and

     WHEREAS, Numerous barriers prevent access to mental health and substance use

disorder treatment. In 2020, the National Mental Health Association found that 22.3 percent of

adults with any mental illness reported not being able to receive needed mental health treatment;

and

     WHEREAS, Critical drivers of an inability to access behavioral health treatment tend to

be insurance-related barriers (e.g., high out-of-pocket cost, limited number of covered

"participating" providers or services, and long waits for care); and

     WHEREAS, Another factor that hinders one's ability to engage with behavioral health

services is a shortage in the supply of behavioral health care providers. In 2016, over half of the

counties in the United States did not have a single psychiatrist; and

     WHEREAS, Suboptimal reimbursement rates often dissuade mental health and substance

use professionals from participating in insurance networks. In 2019, a risk management firm

reported that reimbursement rates for primary care office visits in Rhode Island are 23.7 percent

higher than those for behavioral health; and

     WHEREAS, When a patient is able to locate a behavioral healthcare provider or facility

whose services are covered under their insurance plan, wait times are often extremely long.

According to the State's Behavioral Health Open Beds system, between May and December of

2020, an average of nearly 24 individuals per day found themselves waiting at an emergency

department for inpatient behavioral health services. Month-to-month, this figure fluctuated from

an average of 19 people per day during June 2020, to 29 people per day during August 2020. In

2022, wait times for individuals in emergency departments were extremely long; and

     WHEREAS, The American Psychological Association's 2022 Practitioner Survey found

that 60 percent of psychologists were reporting no openings for new patients, and more than 40

percent were carrying waiting lists of 10 or more patients. About 20 percent said they saw an

increase in demand for treatment from populations of color and younger patients, and the

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expanding workload is taking a toll; and

     WHEREAS, Waiting for needed behavioral health care often leads to degeneration of the

patient's health and, in some cases, death; and

     WHEREAS, The Office of the Health Insurance Commissioner is charged with ensuring

that regulated commercial health insurers maintain adequate networks for insured patients to

access appropriate care when needed; now, therefore be it

     RESOLVED, That this House of Representatives of the State of Rhode Island hereby

respectfully requests The Office Of The Health Insurance Commissioner (OHIC) to study,

publicly report data on, and provide recommendations for addressing the critical inadequacy of

access to behavioral health services in Rhode Island’s commercial health insurance networks; and

be it further

     RESOLVED, That this House hereby requests that said recommendations from OHIC be

submitted to the Speaker of the House, the President of the Senate, and the Governor on or before

March 1, 2024; and be it further

     RESOLVED, That the Secretary of State be and hereby is authorized and directed to

transmit duly certified copies of this resolution to The Office of the Health Insurance

Commissioner and the Honorable Daniel McKee, Governor of the State of Rhode Island.

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