WASHINGTON – U.S. Senator Chris Murphy (D-Conn.), a member of the U.S. Senate Appropriations Committee and co-author of the bipartisan Mental Health Reform Act, lambasted insurance companies on Tuesday for violating mental health parity laws and failing to provide equal coverage of treatment for mental illness, including addiction, and physical illness. During a U.S. Senate Appropriations Subcommittee hearing on “Addressing the Opioid Crisis in America: Prevention, Treatment, and Recovery” with Former Congressman Patrick J. Kennedy, a member of the President’s Commission on Combatting Drug Addiction and the Opioid Crisis, and Dr. Elinore McCance-Katz, Assistant Secretary for Mental Health and Substance Use, Murphy called on the Trump administration to use their authority to enforce parity laws and hold insurance companies accountable. 

Click here to view a video of Murphy’s remarks.

“Behavioral care and addiction care is four to six times more likely to be provided out-of-network than for other medical or surgical care. You’ve got 24 states where the reimbursement disparity between addiction and mental health care is 30-70% higher than for medical and surgical care,” said Murphy. “These are giant, gaping violations of the parity law and there’s no way to explain these differences in reimbursement rates, these differences in network quality, other than the discriminatory treatment of these patients.

Murphy continued, “HHS and Labor have not…issued a report on investigations, and they have not conducted any audits on insurance companies. I would beg you – and I would beg the Department of Labor – use the authority you have to make sure that people suffering from addiction and mental illness are treated the same as people who have cancer diagnoses and orthopedic diagnoses. You can do it, and you have the authority under existing law.” 

Among other things, Murphy’s Mental Health Reform Act strengthened enforcement of mental health parity laws, promoted integrated mental health and physical health, and established new programs to assist those with, or at risk for, mental illness. A fact sheet on his bill is available here. 

According to Connecticut Chief Medical Examiner Dr. James Gill, there have been 538 accidental drug overdose deaths in Connecticut over the first half of the year. The figures include 323 deaths involving fentanyl. If this rate continues, Connecticut will see a projected 1,076 overdose deaths in 2017, up from the 917 deaths last year and nearly triple the 357 deaths five years ago.

The full text of Murphy’s exchanges with Kennedy and Dr. McCance-Katz is below:

MURPHY: Thank you very much, Mr. Chairman.

Congressman Kennedy, this is a scathing indictment of insurance practices across this country. You’ve got data here that says that behavioral care and addiction care is four to six times more likely to be provided out-of-network than for other medical or surgical care. You’ve got 24 states where the reimbursement disparity between addiction and mental health care is 30-70% higher than for medical and surgical care. Is there any way to explain this other than companies being in gross violation of the parity law? Parity is not just about the statement of benefits, right? Parity is also about how you are administering the benefits.

KENNEDY: And I’m happy to say, senator, it’s really encouraging to know that Secretary Acosta – whose Department of Labor oversees ERISA plans, who could do so much to help change this current disregard by insurance plans of their obligations under the federal parity law; he’s looking for more resources to do it. I was just with him last week in his office, and he asked for those resources. He said, ‘I cannot do these letters’ – which is basically his staff being able to flag these insurers for where they’re disregarding the parity law – ‘the way I can and others because I do not have the resources to do it.’

In addition to that, he asked for actually enforcement authority, if you can imagine, for the Secretary of Labor to sue insurance companies. I’m not kidding you. This is coming out of a Republican administration. It was part of our strong recommendations in the President’s report that he get those authorities because frankly, if you don’t enforce parity, the taxpayer ends up picking up the pieces in the criminal justice system, as I said, and in the Medicaid system. 

MURPHY: These are not small violations. These are giant, gaping violations of the parity law and there’s no way to explain these differences in reimbursement rates, these differences in network quality, other than the discriminatory treatment of these patients. 

So let me talk to you, Dr. McCance-Katz, about the powers that you have been granted. So, in the 21st Century CURES Act, on a bipartisan basis, we gave the Department of Labor and the Department of Health and Human Services new authority on the issue of non-quantitative treatment limitations. These are ways in which insurance companies use reimbursement rates, use network registration, use prior authorizations to shut down addiction and mental health care.

So Dr. McCance-Katz, you were given the ability to issue guidance to insurance companies to give them more clarity on when they are violating parity and not violating parity on this issue of non-quantitative treatment limitations. You were given the authority to issue a report listing all the results of closed investigations and the results with respect to parity violations, and you were given new audit authority to go and audit insurance companies where there were five or more reported complaints of parity violations. 

Have you used any of those three authorities: have you issued the guidance; have you issued the report on investigations; have you conducted any audits?

MCCANCE-KATZ: What I can tell you that I know is that we have put in place a portal where people can make complaints, where the Department of Labor does investigate, as does CMS depending on what type of company was the potential violator. And we also – SAMSHA has done Parity Policy Academies times two with the states, and we are working on guidance to individuals about their rights as well as making a toolkit available to insurance regulators within states so that they can enforce parity goals.

MURPHY: You and I have talked about this a number of times, I've talked to the Secretary of Labor, I've talked to our new nominee to HHS. Everyone tells me that they are serious about taking on this issue of mental health and addiction parity, everybody tells me they want to use the new authorities that Republicans and Democrats agreed were necessary in the 21st Century Cures Act. 

For the record, HHS and Labor have not issued that guidance. They have not issued a report on investigations, and they have not conducted any audits on insurance companies. Insurance companies are clearly in violation of the parity laws – that’s what this report says. I'm glad you've opened up this portal, because I’m sure you will get more than five complaints on an individual insurance company, but I would beg you – and I would beg the Department of Labor – use the authority you have to make sure that people suffering from addiction and mental illness are treated the same as people who have cancer diagnoses and orthopedic diagnoses.

You can do it, and you have the authority under existing law. 

Thank you, Mr. Chairman. 

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