Delaware has opportunity to strengthen mental health payer coverage law
The AMA joined the Medical Society of Delaware (MSD) this week in strongly urging the Delaware General Assembly to strengthen its mental health and substance use disorder parity law with Delaware Senate Bill 22 (SB 22), an Act to support “Fair Standards in Mental Health Care.”
Brian Galinat, MD, MBA, MSD president, testified in Senate Chambers on behalf of the AMA and MSD. During his testimony quoted a segment from the AMA letter of support (PDF) submitted by AMA CEO John Whyte, MD, MPH, stating, “It is a sad truth that having insurance benefits and paying monthly premiums does not mean that health insurers live up to the promise of access to care.”
Major provisions of SB 22 that the AMA and MSD strongly support include:
- Requiring coverage of the full continuum of medically necessary care for mental health and substance use conditions, consistent with generally accepted clinical standards
- Ensuring that medical necessity determinations are based on independent, evidence-based clinical guidelines, rather than insurers’ internal criteria
- Improving timely access to care by setting clear standards for network adequacy and requiring coverage of out-of-network care when in-network providers are not available
- Strengthening protections against restrictive utilization management practices that can delay or disrupt care, including limits on prior authorization and concurrent review in key circumstances
- Expanding access to life-saving medications and ensuring they are available without unnecessary barriers
“This legislation is especially critical at a time when demand for behavioral health services continues to rise,” Dr. Whyte wrote. “One in five Delaware residents experiences a mental health issue each year. Delays in care not only worsen health outcomes for individuals, but also increase costs across the healthcare system, including costs associated with avoidable emergency department visits and hospitalizations. By aligning coverage with clinical best practices, this bill will improve outcomes while supporting a more efficient and effective healthcare system.”
Learn more about AMA advocacy in support of mental health and substance use disorder parity (PDF) as well as the recently launched Mental Health Parity Index.
