Most private insurance policies must cover substance use disorder treatment as part of state and federal mental health parity laws. Treatment must be covered "on par" with coverage for medical/surgival treatment.

The Insurance Department is working to complete an examination of how New Hampshire health insurance companies handle claims relating to treatment for substance use disorders, and it plans in the future to look more broadly at coverage for all types of behavioral health services. The Insurance Department's goal: to bring factual basis to the ongoing discussion of barriers to care and how changes in insurance companies’ practices and/or changes to insurance laws could help eliminate those barriers.

Market Conduct Examination

In November 2015, the Department began a formal market conduct examination to look very specifically at how health insurance companies handle preauthorization, claim denials, and utilization review practices for substance use disorder claims. The examination is also focusing on covered persons' access to substance use disorder treatment providers -- including whether the companies' networks are adequate -- and on the companies' systems for handling appeals of claim denials.

The market conduct examination looks at 2015 claims. On Feb. 19, 2016, the Insurance Department presented its preliminary findings to the Governor's Commission on Alcohol and Drug Abuse Prevention, Treatment, and Recovery (a link to the presentation: Insurers' SUD Claims Handling Practices: Preliminary Findings ). After the first phase of the examination, the Insurance Department expanded the scope to include medication assisted treatment and parity. The Department is now working to complete the second phase of this exam and will make a public announcement when findings are complete.

Analysis

In addition to the market conduct exam, the department has commissioned a separate data review of 2014 paid claims. While this review is ongoing, the following is a link to the first report: Report: Analysis of 2014 Claim Data Related to Opiate Substance Use Disorder

In August 2016, the department issued separate analytical report showing that in 2014 and 2015, private health insurance companies paid health providers less than Medicare rates for the most common services associated with treatment of substance use disorders.

Advisory Committee on Insurance Coverage for Behavioral Health and Addiction Services

New Hampshire Insurance Commissioner Roger Sevigny has selected 20 Granite Staters to advise him on issues related to accessing behavioral health services, including treatment for substance use disorders, through private insurance coverage.

The newly created Behavioral Health and Addiction Services Advisory Committee includes New Hampshire state senators, state representatives, substance use disorder treatment providers and advocates, behavioral health providers and advocates, and insurance company representatives. The following link features the full announcment as well as information on the committee's first meeting.

Members of the Behavioral Health and Addiction Services Advisory Committee, with the interests they represent:

Behavioral Health Providers and Advocates

• Robert Feder, MD, Psychiatrist, Private Practice (NH Psychiatric Society)
• Paul Frehner, PsyD, Psychologist, Private Practice (NH Psychological Association)
• Christopher Kozak, Chief Operating Officer, Community Partners/ServiceLink (Community Mental Health Centers)
• Kenneth Norton, LICSW, Executive Director, NAMI-NH (mental health advocate)

Substance Use Disorder Treatment Providers and Advocates

• Amelie Gooding, MLADC, Program Director, Phoenix House-Keene Center (inpatient substance use disorder treatment provider)
• Courtney Gray, JD/MSW, Executive Director, NH Providers Association (substance use disorder treatment providers)
• Michele Merritt, JD, Policy Director, New Futures (substance use disorder treatment advocate)
• Stephanie Savard, LICSW, Chief Operating Officer, Families in Transition (substance use disorder treatment provider)

Insurance Company/Behavioral Health Review Representatives

• William Brewster, MD, NH Vice President and Medical Director, Harvard Pilgrim Health Care
• Stephen Kozak, LICSW, Director of Behavioral Health Services, Tufts Health Freedom Plan
• Richard Lafleur, MD, Medical Director, Anthem New Hampshire
• Andrea Rancatore, LCMHC, MLADC, Supervisor of Medical Management, New Hampshire Healthy Families

New Hampshire Legislature

• NH Senator Jeb Bradley
• NH Senator Dan Feltes
• NH Representative Ed Butler
• NH Representative John Hunt

Other Members

• Lucy Hodder, JD, UNH Director of Health Law and Policy Programs
• Peter Mason, MD, Family Physician (health care provider/NH Medical Society)
• Joseph Plaia, JD, Portsmouth, NH (public member)
• Abby Shockley, MPH, Senior Policy Analyst for Substance Use Services, NH Dept. of Health and Human Services (agency representative)

Helpful links

Nov. 25, 2015 press release announcing the Insurance Department's market conduct examination

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