Committees in both chambers of the General Assembly are hearing testimony on a measure to change how health insurance companies in Maryland make treatment coverage decisions.

The process of what is known as 'utilization review' can be time-consuming and opaque, and criteria may be set by the insurance company instead of clinical standards.

The Senate Finance Committee heard testimony Wednesday on Senate Bill 791, which would require insurers to use expert nonprofit clinical guidelines to make coverage decisions.

David Lloyd, chief policy officer for the nonprofit mental health advocacy organization Inseparable, said the approach will remove barriers to care.

"It puts in place important patient protections to help people get the care they need for their mental health and substance use conditions," Lloyd pointed out.

Testimony on the companion bill will be heard in the House Health and Government Operations Committee on Thursday.

The measure would ensure patients can remain on a drug if it has been authorized in the past, and can keep existing drug coverage for 90 days if they change insurance companies. The bills would also require insurers to establish a real-time benefits check, where prescribers can view an electronic health record to see insurance coverage, drug costs and more.

Lloyd contended it should speed up the authorization process, which can be slow and harmful to people in crisis.

"Particularly for people who are struggling with mental health or substance use challenges, these types of barriers can be really harmful," Lloyd pointed out. "And can make it so that they don't ultimately get the treatments that are critical for their well-being."

If passed, the electronic health record system would be required to begin by July 2026.

Virginia is bolstering mental health care during and beyond Mental Health Month.

Since the pandemic, the need for behavioral health services has grown considerably, especially among young people. Social media and pandemic-era isolation contributed to an ongoing youth mental health crisis.

Bruce Cruser, executive director of Mental Health Virginia, said a spillover effect of the pandemic is the reduced stigma around mental health.

"You have more people willing to talk about their mental illness or the fact that they're not feeling well," Cruser observed. "It's good that more people are open about it and more people are asking for help when they need it. I mean, that's a good thing. The bad thing is that there's so much need."

The state has made progress in funding mental health services. Virginia's new budget provides an almost $2.5 million increase in children's mental health funding to $15 million for 2025 and 2026, but many other funding pots have been reduced, redirected or eliminated.

While the state is broadening the services provided, barriers to accessing them remain. Beyond existing stigma in certain communities, Cruser pointed out there are many reasons people are unable to get the help they need.

"For some people it's cost, because they still might not have insurance or know about available insurance options," Cruser acknowledged. "But even with insurance, there can be high copays, etc. But another one is availability of the service."

The federal Health Resources and Services Administration designated all of Virginia under a mental health professional shortage. Other reports show the state has few areas where youth behavioral health services are close to sufficient.

Georgia is taking on its mental-health care challenges head-on through new legislation.

One bill is aimed at increasing the number of providers in the state. Senate Bill 480 offers loan repayment assistance to mental-health care professionals who choose to work in underserved areas.

Rep. Sharon Cooper, R-Marietta, highlighted the state's access landscape, noting that of its 18 public health districts, 12 are located in rural areas. She said the goal is to ensure equitable access to mental-health services for all.

"Georgia is terribly short of psychiatrists, psychologists, social workers, marriage and family providers, all levels of people that deal with various aspects of mental illness," said Cooper.

According to the Rural Information hub, most of Georgia struggles with having enough mental-health providers. The data shows out of 159 counties, only six have no shortage, and two only have shortages in parts of the county.

Cooper elaborated on the multifaceted challenges Georgia faces in mental-health care, citing historical underinvestment and rapid population growth as contributing factors to the current shortage. She described the evolution of mental-health care policy in Georgia, including previous legislative efforts to promote parity between mental and physical health care.

"We are trying to make up for mistakes of the past and trying to do what's right for mentally ill people and to put their illness on parity with anybody that would have a gallbladder or heart disease," Cooper added.

Cooper pointed out that in this past legislative session, 19 bills were signed to help increase the state's ability to care for mental- and behavioral-health needs. Other legislation includes SB 373, which helps provide expedited licenses to marriage and family therapists.


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New York's 2025 budget improves access to mental-health services.

Budget legislation stipulates commercial insurers have to pay rates similar to Medicaid for in- and-out-of-network behavioral health services.

While many New York adults can access care, younger people can't because of insurance coverage.

Matthew Shapiro - senior director of government affairs for the National Alliance on Mental Illness-New York State - said people are glad this broadens access to often limited mental health services.

"We hear from people all the time that they can't access care, they can't find a psychiatrist, they can't find a social worker, they can't find someone who'll prescribe medication," said Shapiro. "It can be very, very difficult, especially in parts of Upstate New York where these services just aren't readily available."

Some insurance companies pushed back, saying it would raise customers' rates. Shapiro noted that this will hopefully resolve long-standing issues in obtaining mental-health care.

A state Attorney General's office report finds 86% of the listed, in-network mental-health providers were either unreachable, not in-network, or not accepting new patients.

The budget allocates millions of dollars to other programs that establish new inpatient psychiatric beds statewide, and increase mental health support for first responders.

But, Shapiro noted that other insurance companies' barriers prevent New Yorkers from getting the best mental-health care they can.

"It's so important those people get the medications their doctor believes are best for them, and their individual set of symptoms as quickly as possible," said Shapiro. "So, eliminating things like fail-first procedures and what they call step-up procedures."

He added that these policies can significantly set back a person's recovery.

A 2024 survey finds 1 in 5 adults required to fail first had to visit the emergency room or be admitted to a hospital as a result of the policy.




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