Murphy Urges Federal Government to Do More to Enforce Mental Health Parity Laws, Address Children's Mental Health Crisis

MURPHY: "Thank you very much. Thank you to all of you for your tremendous work. And for your time before the committee today

"Senator Cassidy and I, along with Senator Murray's help, and others have been really focused on this issue of mental health parity. We've passed several different pieces of legislation through this committee, got signed by the president since 2016.

"The latest piece of legislation we passed required the administration to do audits of insurance plans to see if they were actually in compliance with federal parity laws. What we know is that while your Statement of Benefits will often tell you that you have access to mental health treatment, when you go to get that treatment, you will face what we call non quantitative treatment limitations, all sorts of prior authorization, bureaucracy, red tape that stands in the way of you getting that treatment.

"I forget the exact number that the Department surveyed, but about 50 plans, and the report we were given in January, essentially came to the conclusion that not a single one of these plans was in compliance with parity laws.

"And interestingly, when they notified the plans that they had set up these burdensome barriers to mental health care that they didn't have on the physical health side, the plans fixed those issues. And all of a sudden, thousands of people had access to mental health that they didn't have.

"Secretary Delphin-Rittmon, great to see you. I want to ask you a question. Because I noticed that in the SAMHSA joint block grant application, there's some language in there that says resources should be used to support not supplant services that will be covered through the private, through private and public insurance.

"And so you kind of reference the fact that, you know, it's supposed to be insurance that's on the frontlines here, and then we're gonna come in on the back end, but that sentence also sort of suggests a knowledge that insurance is not actually providing the kind of reimbursement that it should.

"So can you talk a little bit about how you approach this issue? I mean because we don't want federal dollars to essentially be filling in what insurers should be covering. And this report we got in January tells us that we just have massive noncompliance in the insurance industry with existing parity laws."

DELPHIN-RITTMON: "Thank you, Senator Murphy, and it's good to see you as well. And, you know, parity is such an important issue for the American people in terms of health care and ensuring that both primary care and behavioral health is appropriately covered.

"I mean, as you know, SAMHSA has no regulatory authority here. But we do see ourselves as a, in some instances, a convener or we help to give states information around how they can advocate and even families. You know, we've convened policy academies.

"We feel that it's important for individuals as well states and communities to know what the parity laws are. And so those policy academies, which we are looking to bring back, additional policy academies, are one strategy for helping states have information around how to, you know, how to work with providers, and to promote advocacy in this area.

"And we have resources as well for individuals and families. And we feel that's important as well, because people need to know how to advocate if they're not having coverage for services and support, which they feel that they should be covered."

MURPHY: "I think that's important, but insufficient, right? I mean, families ultimately are not going to be able to enforce this right, because the sort of details of obstruction of care are so byzantine often. It really is has to be regulators that do this job. And we definitely have more opportunity at the federal level to enforce those laws.

"Just one quick other topic for you, Ms. Johnson, wanted to talk to you about the state of pediatric mental health. We talk about this problem we have with getting enough practitioners, but we've got tens of thousands of pediatricians, who often, frankly, don't have a lot of background in mental health. And it seems to me one of the easy things we could do is just have a conversation with the profession to make sure that either in the initial training or in some postgraduate training opportunity, more pediatricians have a background in mental health and substance abuse, but particularly in mental health."

JOHNSON: "Thank you for the question, Senator. I think that that is where we should be headed in pediatric and all clinical training that clinicians across the board need to have training and exposure to mental health and substance use disorder needs and conditions. We need, in my view, we need primary care to be inclusive of mental health.

"And so that is what we're working on at HRSA and what we're going to continue to push forward on going forward. Thank you for your leadership on the pediatric Mental Health Access Program. We really see that as an exciting model for how we can continue to help clinicians who are in practice now get the kind of mental health supports that they need to build up their capacity.

"What we're seeing anecdotally from that program is really people being able, clinicians being able, to handle more and more mental health conditions and refer fewer. So we're excited about continuing to grow that program."

MURPHY: "And just very quickly, I that program is a mechanism by which pediatricians can get a phone or virtual consult with a mental health practitioner. I agree that program, which is included in the 2016 Mental Health Reform Act, it has already shown positive results, but that can be partnered with the pediatricians themselves having a greater level of expertise and something that hopefully this Committee will work on."

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