Joint Committee on Mental Health and Substance Abuse
Hearing on the Merger of Beacon Health Strategies
and Value Options
October 9, 2014
Testimony of Matt Selig, Executive Director, Health Law Advocates
Chairwoman Malia, Chairwoman Lively and Members of the Committee, thank you very much for the opportunity to testify today. My name is Matt Selig and I am the Executive Director of Health Law Advocates (HLA). HLA is a public interest, non-profit law firm that provides free legal assistance to low-income Massachusetts residents denied access to health care. We are the only legal aid organization in Massachusetts focusing exclusively on breaking down barriers to health care.
One of our top priorities is helping consumers having difficulty accessing mental health and substance abuse services. We represent consumers with all types of coverage (including BHS and MBHP) who primary diagnosis is mental illness or substance abuse disorders and face obstacles to behavioral health services.
Our clients have difficulty accessing all types of services on the continuum of care and they have particular difficulty accessing intermediate services like residential treatment, partial hospitalization and so on. Typical obstacles to care for HLA clients in need of residential or even inpatient care are concurrent review policies where providers and their patients must repeatedly demonstrate the need for services every day or couple of days even for the sickest patients. This puts a lot of pressure, including extreme financial pressure, on patients and families and detracts from treatment goals.
We have also been particularly concerned with health plan compliance with the federal and state mental health parity laws which require non-discriminatory coverage for mental health and substance abuse services. Ensuring parity becomes harder with behavioral health ‘carve outs’ like BHS and MBHP because separate entities are managing behavioral health and non-behavioral health services. HLA has been strongly urging the Division of Insurance to enforce the parity laws and we have had ongoing dialogues with BHS in particular, but also other health plans about parity compliance.
Transparency in behavioral health insurance is also a great concern to HLA as we represent consumers. Health plans across the board often deny coverage for behavioral health services citing vague, non-specific reasons. It can also be difficult for consumers or even their legal representatives to obtain copies of all the medical necessity guidelines relied on by health plans.
Speaking directly to the merger of BHS and Value Options, we not saying at this time that this is a bad deal for consumers, but we are recognizing that this new arrangement will impact a huge number of Massachusetts residents as the combined company will manage behavioral health benefits for the vast majority of MassHealth and GIC members.
The merger warrants attention from the state to ensure that MassHealth and GIC consumers are not negatively impacted. Aside from the concerns we and other consumer advocates are raising today, we also recognize an opportunity for positive outcomes from this merger. For one, having the combined headquarters in Massachusetts provides a special opportunity to work with the combined company to advocate on behalf of our clients and improve consumers access to services.