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Committee hears SB646FN; CMHCs press insurers for coverage parity on community-based services
Summary
SB646FN was introduced to address reimbursement disputes between commercial carriers and community mental health centers; CMHCs and advocates urged parity for targeted case management and functional support services, while insurers and the insurance department recommended technical fixes and coding-based solutions under ongoing stakeholder talks.
Concord — Lawmakers reviewed SB646FN, a bill intended to address billing and reimbursement problems affecting community mental health centers (CMHCs) and their commercially insured clients.
Senator David Rochefort introduced the bill as a ‘‘blunt instrument’’ intended to bring payers and providers to the table after months of stakeholder meetings. He said some CMHCs are providing services for which commercial carriers do not reimburse at levels comparable to Medicaid, creating uncompensated-care pressure on centers that serve people with serious mental illness (SMI).
DJ Betancourt, commissioner at the Insurance Department, and staff cautioned that the draft bill could have unintended technical consequences. The department urged retaining Medicare (not Medicaid) as a benchmark in certain statutory language, and warned that tying commercial reimbursement to Medicaid rates could backfire because Medicaid rates vary by state and are typically lower than commercial payment rates.
Chris Kozak, president and CEO of Community Partners (a CMHC), described services such as targeted case management and functional support services that Medicaid covers for SMI patients but commercial carriers often do not. Kozak argued these are evidence-based, clinically appropriate components of rehabilitation and community-based treatment: “The 2 services... have long been deemed not medically necessary by commercial carriers in the state,” he said, urging parity so patients with commercial insurance receive the same standards of care.
Carrier representatives acknowledged the issues are narrow in scope, flagged that the affected commercial population at some CMHCs is small, and said they are actively working with CMHCs to add or reconcile codes (Anthem described three specific procedure-code gaps under discussion). Carriers urged targeted contract or coding solutions rather than broad statutory changes.
Patient advocates (NAMI) highlighted individual harms, including one client with a $9,000 unpaid bill after losing functional support services when moving to commercial insurance; advocates said lack of coverage can increase hospitalization risk and financial distress. The committee closed the hearing while stakeholders committed to continued negotiations; no committee vote is recorded in the transcript.
