State senators keep wraparound mental health initiative alive

After the New Hampshire House sidelined an effort to require private insurers to cover wraparound mental health services, the Senate made a last ditch effort to keep it alive.

Senate Bill 498 would’ve required insurance companies to cover a state-run program called FAST Forward that offers wraparound services — a more holistic form of mental health treatment that seeks to connect disparate and complicated social services and care programs — for New Hampshire children. The bill also would’ve created a board with the power to assess fees on companies in order to fund the care.

SB 498 was approved by the Senate in March. When the bill got to the House, Gov. Kelly Ayotte waded into the debate with a pressure campaign on representatives to send the bill to her desk. On Thursday, representatives bucked her calls and voted, 188-164, to send the bill to interim study, a parliamentary move that sidelines the bill for at least another year so lawmakers can continue working on it. The issue has been debated by state lawmakers for several years in a row.

Proponents of the bill argue the service is the most effective form of care and that offering it is more cost-effective because it prevents mental health challenges from escalating to crises that require more intensive and costly interventions, such as psychiatric hospitalization. Opponents have argued SB 498 would increase rates for all New Hampshire insurance customers and that it amounted to a new tax. Opponents contend that the state doesn’t know what the final cost of this measure could be.

Hours after the initial vote, a group of House lawmakers attempted to revive SB 498 by calling for a vote to reconsider. Rep. John Hunt, a Rindge Republican who chairs the Commerce Committee, fought against the vote to reconsider by promising that lawmakers will soon strike a deal with Anthem and other private insurance companies for them to better cover mental healthcare.

“I want to reconfirm to all of you that I promise you, I guarantee you, that the Commerce Committee will have this issue solved in September,” he said. “We have a deadline, that was agreed upon with the governor, that August 31, the insurance companies have to demonstrate one way or the other whether they can provide the service or not.”

Otherwise, he said, they’ll take up legislation. Ayotte wasn’t convinced.

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“It’s disappointing to see elected representatives choose subsidizing insurance companies over kids’ mental health care,” the governor said in a statement. “Anthem and other carriers must be held accountable for denying families coverage for these critical services. I’m not giving up on this, and I’ll continue working to ensure our children — and their families — get the care and support they need.”

Ayotte previously railed against the agreements the insurance companies were trying to reach with lawmakers, telling reporters earlier this month that “insurers like Anthem keep claiming that they’re negotiating in good faith, but they’re clearly stalling because they don’t want to cover mental health coverage for children, and it’s wrong.”

Anthem — the state’s largest insurer and a frequent target of Ayotte in the past few weeks — has pushed back against those criticisms. Spokesperson Jim Turner said in a statement Thursday that “Ayotte’s recent criticisms of our company (and industry) regarding coverage of behavioral healthcare for children have been inaccurate and misleading. Over the past two years, Anthem has taken significant steps to increase access to mental healthcare for children and adults and to reduce barriers to that access — including being the first insurer to eliminate copayments and other forms of cost share for all children and teens for these services.”

Advocates of mandating the FAST Forward program argue that it is more effective than the types of services Anthem covers and that the insurance companies have a perverse incentive to deny coverage until a mental health crisis grows so severe that it requires state-funded intervention.

 Turner said they “appreciate the New Hampshire House for hearing our concern that SB 498 would have placed a new, undefined tax on our employer-customers and members. Despite the recent unwarranted attacks, we will continue working in good faith with the state and care providers on this issue.”

However, in the later hours of a marathon voting day on the other side of the State House’s second floor, senators again revived the measure. Still hoping to convince the House to change its mind, they tacked provisions onto a different unrelated bill to keep the effort going. House Bill 1323 originally sought to define parental alienation in law and create legal standards family court could use to consider it. After senators amended it, it also, like SB 498, requires insurers to cover FAST Forward.

HB 1323 will now return to the House. Senators, mental health advocates and the governor will likely spend the next week pressuring representatives to change their vote. The House will have the options to concur, which would send the FAST Forward measure to Ayotte’s desk; reject it outright; or enter negotiations with the Senate for a compromise through the committee of conference process.