Tool will help policymakers increase access to mental health and addiction care amid historic rates of overdoses and suicides across the nation

Today, The Kennedy Forum released the Jim Ramstad Model State Parity Legislation, which will hold health insurers accountable for discriminating against those with mental health and substance use disorders by wrongly denying coverage of care.

Jim Ramstad served in the U.S. House of Representatives from 1991-2009, representing Minnesota’s 3rd congressional district. He joined former Democratic Rep. Patrick J. Kennedy as the lead Republican cosponsor of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which requires insurers to cover treatment for mental health and substance use disorders no more restrictively than treatment for illnesses of the body, such as diabetes and cancer.

The new model bill named for Rep. Ramstad, who passed away in November, is based off of California’s groundbreaking new law, Senate Bill (SB) 855, which The Kennedy Forum spearheaded earlier this year (SB 855 takes effect on January 1, 2021). View the model legislation in its entirety here.

The legislation was developed in partnership with the American Psychiatric Association, the American Psychological Association, NAMI, Mental Health America, the National Council for Behavioral Health, and more than 30 additional national organizations. The American Psychiatric Association is currently working to tailor it to all 50 states’ unique codes so that advocates can work rapidly to enact its requirements across the country.

Both SB 855 and the model bill would require that all insurers follow generally accepted standards of behavioral health care when making medical necessity decisions, and use criteria consistent with these standards. By putting these critical requirements in place, states can improve access to mental health and addiction care at a time of rapidly escalating needs.

“Our nation was in the midst of mental health crisis before COVID began,” said former Congressman Patrick J. Kennedy, founder of The Kennedy Forum. “We cannot meet the increasing mental health needs of Americans and fully recover from this pandemic if our insurers are not being held accountable for treating the brain on par with the body.”

Generally accepted standards of care were addressed in detail in a recent landmark federal class-action ruling, Wit v. United Behavioral Health (UBH), which found the nation’s largest insurer was using flawed medical necessity criteria to wrongly deny mental health and addiction coverage to more than 50,000 patients nationwide, half of whom were children or adolescents. The court also found that United used flawed medical necessity criteria to “mitigate” compliance with the MHPAEA.

Last month, the federal court issued a 10-year injunction against UBH, ordering it to reprocess approximately 67,000 denied mental health and addiction claims and to use criteria from non-profit clinical specialty associations, such as the American Society of Addiction Medicine, which are consistent with generally accepted standards of care.

Alarmingly, the use of flawed medical necessity criteria that allow insurers to wrongly deny mental health and addiction coverage is commonplace. In a recent review of mental health criteria, for example, the New York Office of Mental Health found all plans’ criteria to be flawed. By using flawed criteria, insurers often inappropriately limit mental health and addiction coverage to treating short-term symptom reduction, while refusing to cover ongoing treatment for chronic mental health and addiction conditions.

The Kennedy Forum stands ready to assist advocates and policymakers across the nation in utilizing the Jim Ramstad Model State Parity Legislation in their states.

The following organizations have endorsed the legislation: American Academy of Child & Adolescent Psychiatry, American Association for Marriage and Family Therapy, American Foundation for Suicide Prevention, American Psychiatric Association, American Psychological Association, American Psychoanalytic Association, The Carter Center, Chronic Disease Coalition, Community Catalyst, Council of Autism Service Providers, Depression and Bipolar Support Alliance, Eating Disorders Coalition for Research, Policy & Action, Faces and Voices of Recovery, Families USA, Inseparable, Mental Health America, NAMI, The National Alliance to Advance Adolescent Health, National Association for Behavioral Healthcare, National Association for Children’s Behavioral Health, The National Association for Rural Mental Health, National Association of Addiction Treatment Providers, National Association of County Behavioral Health and Developmental Disability Directors, National Association of Social Workers, National Council for Behavioral Health, National Eating Disorders Association, National Federation of Families, National Register of Health Service Psychologists, Partnership to End Addiction, Psychotherapy Action Network (PsiAN), Residential Eating Disorders Consortium, Shatterproof, Treatment Advocacy Center, The Trevor Project, The Voices Project, Well Being Trust, and 2020 Mom.

Watch Patrick J. Kennedy's tribute video to Jim Ramstad here.

2020 Mom is proud to have endorsed this framework and to have been involved in shepherding it through the legislative process in California this year.