Illinois legislators have advanced two measures pushed by proponents of reform in the state’s behavioral health system that are intended to expand the insurance coverage available for those seeking care.
The bills, both of which were passed by the House on April 19 and are now before the Senate, aim to combat what supporters say are inequities in access to support systems for people suffering mental health and substance abuse issues, which have remained at stubbornly high rates following the COVID-19 pandemic.
A bill introduced by state Rep. Lindsey LaPointe, a former social worker who represents a chunk of Chicago’s Northwest Side and chairs the House’s Mental Health and Addiction Committee, is designed to encourage more behavioral health providers to enroll in commercial insurance networks and, in turn, reduce costs for some seeking their services.
The bill’s language was crafted with help from Illinois-based mental health organizations, such as the National Alliance on Mental Illness’ Chicago chapter and the nonprofit social service agency Thresholds, which treats severe mental health and substance use disorders.
While the majority of Thresholds clients do not use the types of insurance this bill would regulate, Heather O’Donnell, the agency’s senior vice president of public policy and advocacy, said that the work still matters, as it can prevent people from reaching a point of crisis.
“It takes somebody with a serious mental illness about 10 years, 10 solid years, before they’re able to find the right kind of treatment and support to stabilize their condition,” O’Donnell said in an interview. “Imagine a day when it doesn’t take 10 years, it takes a month or two. That’s what we should be focused on. And people who are able to access a provider that can help them see the signs of serious mental illness, that’s what we are striving for.”
Another bill, introduced by state Rep. Mary Gill of Chicago, would require municipalities across the state to cover couples and family therapies under insurance plans for police officers and firefighters and their spouses.
LaPointe’s bill aims to assure that mental health or substance use disorder benefits are as favorable as medical or surgical benefits under group health plans and insurance.
According to a report by the nonprofit Research Triangle Institute based on data collected between 2019 and 2021, in-network reimbursement levels nationwide were about 22% lower for behavioral health providers, such as psychiatrists and psychologists, than medical providers such as physician assistants.
As a result, fewer clinicians choose to accept insurance, leaving patients with fewer options for services if they cannot afford to pay out of pocket, LaPointe said.
“Basically, they’re like … I’m not going to join an insurance network. If people want to come see me, they can just pay out of pocket,’” LaPointe said.
The RTI report said patients seeking behavioral health care in the U.S. went out of network 3.5 times more often than those seeking medical and surgical care.
LaPointe said state intervention is necessary to correct discriminatory insurance practices and make behavioral health care more widely accessible. Her bill would set a minimum percentage for behavioral health professionals to be reimbursed for care covered by state-regulated commercial insurance plans, which represent about 40% of all commercial insurance plans in Illinois.
Reimbursement rates would need to be at least 141% of the “Medicare rate for the mental health or substance use disorder service delivered,” under the bill. That figure is comparable to the reimbursement rate for physical health services, LaPointe said.
“We’re talking about a 40% to 50% increase in reimbursement rates, which is a pretty big incentive for providers to actually join networks,” she said.
While the minimum reimbursement rate requirement is the provision that figures to have the most impact, other aspects of the bill would also address other issues that affect accessibility of behavioral health services, LaPointe said.
The bill would require insurance companies to cover work by behavioral health providers who are still in the process of earning their licenses and are in training under direct supervision of a licensed professional. That would quickly expand options for those seeking support covered by their insurance.
After consulting practitioners and insurance companies, LaPointe also added to the bill requirements for coverage of 60-minute therapy sessions and of multiple behavioral health services received on the same day.
“This happens a lot — people will go to their provider, and they might have a therapy session, and then also see their psychiatrist for 15 minutes,” LaPointe said. “And what insurance companies do is they think, ‘Oh, no, we’re only paying for one of those things’ … because there’s no law saying that they can’t.”
She said therapists accepting insurance are currently encouraged to cap their sessions at 45 minutes, as networks often require additional documentation for those who try to bill by the hour. “They were being driven to give people less,” LaPointe said.
While insurance industry lobbyists continue to speak out against the reimbursement floor, they haven’t taken issue with the other proposed updates in statute.
In an interview, Kathryn Morthland, director of policy and advocacy for the Illinois Life and Health Insurance Council, commended the bill’s sponsors for taking insurance company concerns into consideration.
But she argued that the mandated minimum reimbursement rate could remove incentives for behavioral health practitioners who are already being paid at a rate higher than that level. Morthland said the rate requirement “could create a ceiling, rather than a floor,” and that negotiations over that provision will continue as the bill comes before the Senate.
While insurance companies would bear most of the burden of implementing the requirements, LaPointe said the state would need about $11 million for state employee health plans. She said cost shouldn’t be a major barrier “in the grand scheme of things,” but will likely be debated further.
“We’re just so far behind behavioral health and like, we’ve been focusing on some other things to keep our heads above water and this is the next natural step,” LaPointe said.
The more narrowly tailored bill sponsored by Gill aims to close what some mental health practitioners say is a gap in insurance coverage for first responders in some Illinois municipalities, including the city of Chicago.
Kathleen McShane, who owns and practices at Begin Within Therapy Inc. in Chicago, said many clients with insurance plans through their work as police officers or firefighters lack coverage for couples or family therapy.
“We rarely see it as a denied service” for other insurance plans, McShane said in an interview. “So then to have it be specific to this population especially was concerning.”
Behavioral health conditions including depression and post-traumatic stress disorder affect first responders at a rate 10% higher than the general population, according to a report from the U.S. Substance Abuse and Mental Health Services Administration. Firefighters and police officers also are at a higher risk of suicide compared with the general population.
These issues often affect first responders’ home lives and spouses, McShane said.
“There is more stress due to the nature of their job; there is stress from the burdens of shift work,” she said. “You do see higher rates of substance abuse. There can be higher rates of domestic violence. It’s important to have supports in place when we have these facts.”
The bill introduced by Gill, a Democrat representing portions of the Southwest Side and southwest suburbs, would mandate state, county and municipal government insurance plans cover couples and family therapy for police officers and firefighters as well as their spouses or partners. Without coverage, a single appointment can cost upward of $200, a significant barrier to many, McShane said.
The bill passed the House without a no vote, and has support from groups including the Illinois Counseling Association, the Illinois Sheriffs’ Association and the Associated Fire Fighters of Illinois.
Chicago Fire Fighters Union Vice President Erik Steinmetz said he has been pushing for coverage of family and couples therapies for city employees, and that he believes cost is a major reason more first responders don’t seek therapy.
“This is one of those things where it’s savings in the long run — if you can get people treatment ahead of time,” Steinmetz said in an interview. “It saves some people from missing work and having catastrophes happen in their life because of it.”
