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Insurance

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In an effort to gain a better understanding of providers’ ongoing needs and challenges in addressing third party liability (TPL) claims, RCPA is requesting that our members complete the following TPL Survey. This survey was designed to capture critical barriers so as to develop strategic pathways to ensuring access and equity.

In January 2024, Governor Shapiro announced that commercial insurers would be required to meet their obligations under Pennsylvania law to provide coverage for autism benefits by categorizing autism services as a mental health benefit. With this action, all autism services will be treated as mental health services, leading to greater mental health parity for those with autism spectrum disorders. The goal of the Shapiro Administration’s legislation is to improve much-needed access to services for individuals diagnosed with autism, a challenge that the Commonwealth has faced for decades.

As providers of mental health, autism services, and substance abuse disorders, our members treat a vast array of individuals who are insured by either commercial insurance, Medicaid insurance, or both. For those who have just Medicaid, billing is simple: providers bill the Medicaid payor, and they pay the claim. The same is true for those who have just commercial insurance if the provider is in network with the commercial insurance carrier.

Complications occur when an individual has both commercial insurance and Medicaid. Coordination of Benefits (COB) requires that the commercial insurance is billed first, and then Medicaid pays what is not covered. Services like the delivery of Applied Behavior Analysis (ABA) or Intensive Behavioral Health Services (IBHS) are two good examples of services that can fall into this category.

With this survey, we hope to gather information that will assist RCPA and members in addressing the barriers in insurance coverage for children, families, and individuals in Pennsylvania. We thank you for taking the time to complete the survey so that we can continue to seek solutions to access services in our communities.

If you have any questions, please contact RCPA Policy Associate Emma Sharp.

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The Pennsylvania Insurance Department (PID) and the Pennsylvania Department of Human Services (DHS) have put a survey together to try to gain an understanding of the insurance market for both foster care and childcare providers. Both agencies have heard about difficulties experienced by these providers in finding insurance coverage, coupled with the rising cost of insurance for foster care and childcare. You can also read the letter from Acting DHS Secretary Valerie Arkoosh as well as Acting Commissioner of the PA Insurance Department Michael Humphrey, which outlines the importance of completing the survey. Complete the survey here.

Please share this survey where you feel appropriate, and reach out with any questions or concerns you may have. This survey will close Monday, July 31, 2023. Feel free to contact PID’s Caolinn Martin or DHS’ Jameekia Barnett with questions regarding the survey. If you have any additional questions, please contact RCPA MH Policy Director Jim Sharp.

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Pennsylvania Acting Insurance Commissioner Michael Humphreys announced today that the Pennsylvania Insurance Department (PID) has strengthened its review of mental health and substance use disorder coverage in 2024 health plans. Insurers under PID regulation must file their plans with the Department for approval. Now, for 2024 filings, PID is enhancing its compliance review of mental health and substance use disorder parity requirements to prevent potential violations before they have a chance to harm Pennsylvania consumers.

Read the full press release.

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In recognition of Mental Health Awareness Month, the Pennsylvania Insurance Department is highlighting its continued work to ensure that insurers operating within the commonwealth are following state and federal parity laws, allowing those faced with mental health or substance use disorders continued access to needed care.

Under the Affordable Care Act (ACA) and Mental Health Parity and Addiction Equity Act (MHPAEA), health insurance plans and insurers must offer mental health and substance use disorder benefits that are no less restrictive than their coverage for medical or surgical care. These benefits include quantitative limitations (copays, deductibles, and limits on inpatient or outpatient visits that are covered) and non-quantitative limitations (pre-authorizations, providers available through a plan’s network, and what a plan deems “medically necessary”).

Read the full press release.

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