Arizona Passes Sweeping Legislation on MH Parity, Access to Care
Abstract
Key to the bill’s unanimous approval in the legislature was the hard work of the district branch and coordination with other Arizona health organizations.
The Arizona Psychiatric Society, through advocacy, education, and outreach, supported a successful omnibus bill that not only requires insurers in the state to comply with the federal mental health parity law, but also improves data collection and expands access to mental health care for children.
The legislation, known as Jake’s Law, addresses a critical need for mental health care in Arizona. In 2017, the suicide rate in the state was 24% higher than the U.S. average. Suicide is the second leading cause of death for those aged 15 to 34 in the state and the eighth leading cause of death overall.
Though Jake’s Law is broad and comes with an $8 million price tag, it sailed through four committee hearings and each chamber of the Arizona legislature without a single vote cast against it. Then, Arizona Gov. Doug Ducey, a strong supporter of the legislation, signed the bill without delay on March 4.
“Psychiatrists have a very important role to play in the health community and the larger community as a whole. We were able to make that point in a collaborative, constructive way,” says Don J. Fowls, M.D.
Key to the legislation’s passage was the combined efforts of a range of advocates and experts, said Don J. Fowls, M.D., president of the Arizona Psychiatric Society (APS). “APS played a leadership role in bringing us together as a community including public and private insurers,” he said. “It was an opportunity for us as psychiatrists to engage with not just the medical community, but the nonmedical community, as well.”
“State law is really about persistence and fortitude,” said Teri Harnisch, executive director of the APS. “But something truly magical happened in the passage of this law.”
Enforcing Mental Health Parity
With the passage of Jake’s Law, Arizona joins a growing number of states passing APA’s model mental health parity legislation, whose goal is to improve insurance companies’ compliance with the Mental Health Parity and Addiction Equity (MHPAEA) Act. Insurers tend to comply with some, but not all, of MHPAEA’s components, and states have primary enforcement authority over insurers selling policies in their states. Indiana, Maryland, and West Virginia also passed APA’s model legislation in March. In total, 12 states introduced the model legislation this year, though most state legislatures closed due to the COVID-19 pandemic.
Jake’s Law, which was sponsored by Sen. Kate Brophy-McGee and Rep. Jeff Weninger, creates numerous transparency requirements to guarantee that insurers are complying with federal parity laws, including requiring insurers to file a comparative analysis report with the Department of Insurance (DOI) every three years or when there is a substantive change to a health plan. It also creates the Mental Health Parity Advisory Committee and requires Arizona’s DOI to establish a consumer-friendly webpage for resources relating to parity and how to file parity violation complaints. It also provides $200,000 to DOI for staff and resources to ensure compliance with the new law.
“Parity will mean there will be a greater number of providers who will take private insurance, and more patients who will get the help they need,” says Jasleen Chhatwal, M.D.
Additionally, the legislation creates a Suicide Mortality Review Team to improve the accuracy of suicide data in the state and requires the Department of Health Services to establish new discharge protocols for patients admitted to an inpatient facility due to suicidal ideation or a suicide attempt.
And finally, the legislation expands access to mental health care for children in schools. It prohibits insurers from denying claims for mental or substance use treatment because the services were delivered in an educational setting. The law also establishes a fund for privately insured students who cannot afford their copays or deductibles.
APS President-elect Jasleen Chhatwal, M.D., said the legislation may have come just in time, as the COVID-19 pandemic tests the capabilities of Arizona’s mental health system. “With this parity legislation, as we recover from COVID-19 over the next few years as a community, we’ll be able to provide a better quality of service to more people,” she said.
A Collaborative Effort
The APS has been advocating for parity enforcement in the state for years, and it was invited to join the Arizona Coalition for Insurance Parity. The group was led by the JEM Foundation, created by Ben and Denise Denslow in memory of their son, Jacob Edward Machovsky, who died by suicide when he was 15 years old. He was the inspiration behind naming the legislation Jake’s Law.
A variety of organizations and people participated in the development of Jake’s Law, including health organizations, insurers, suicide prevention and mental health advocacy organizations, clinicians, hospitals, and concerned citizens.
APS members provided guidance and education to the group, and Fowls led a legislative work group of health care professionals and insurers and also testified before lawmakers. Tim Clement, M.P.H., APA’s director of legislative development in the Division of Government Relations, provided vital support in crafting the legislation.
The stories and experiences with suicide that families shared helped build support for the law. Without those stories, Harnisch said, the legislation may not have caught the attention of Arizona’s policymakers.
“For once, mental health became as American an idea as freedom and apple pie,” she said. “Legislators really understood, through the personal stories and the education, that lives get lost when we don’t provide care.”
Ultimately, the success of the legislation was rooted in the combined efforts of numerous groups of people, including psychiatrists and families advocating for mental health access, Fowls, Chhatwal, and Harnisch said.
“At the end of the day, the bill succeeded thanks to this tireless village of people who made the calls and showed up to committee hearings,” Chhatwal said. “The fact that we worked with all partners in the community moved this legislation forward.” ■
APA’s model parity legislation, tailored for each state, is posted here.
