New law eliminates insurance pre-approval for crisis mental health, substance use care


New Hampshire Bulletin

Published: 08-24-2023 9:30 AM

Insurance companies in New Hampshire can no longer require their members to get prior authorization before getting coverage for emergency mental health or substance use care when it is provided by a mobile crisis team, outside a licensed hospital. 

The new law, Senate Bill 85, is intended to make it easier for people to get insurance coverage for crisis care immediately, outside the emergency room, without having to wait for an insurance company’s approval. 

The state Department of Insurance called the change, which took effect this month, a “very important” change Tuesday, during a review of its 2023 legislative priorities.

“I’m very happy to see that one go through,” said Jason Dexter, who oversees life and health insurance for the department. 

The law follows the state’s expansion in 2022 of its response to the growing mental health and substance use disorder crisis. Lawmakers added a 24/7 crisis call center and spent $52.4 million to put a mobile crisis response in all 10 counties, more than doubling the three that previously existed, in Concord, Manchester, and Nashua.

A bipartisan initiative led by Senate President Jeb Bradley, a Wolfeboro Republican, prohibits insurers who offer coverage for mental health care or substance use disorder treatment from requiring pre-approval to get that care from a mobile crisis team or for emergency stabilization services. Previously, insurers could require that pre-approval if the care was provided outside a licensed hospital emergency facility

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Lawmakers, state leaders, and behavioral health treatment providers have said the crisis call center and mobile crisis teams are an important alternative for people who can safely stay home, out of over-overcrowded emergency rooms, with timely treatment.

On Wednesday, there were 28 adults being held in emergency rooms for inpatient care under involuntary emergency admission petitions, which are used when danger to self or others is a concern. A shortage of treatment beds has also delayed hospital care for children in crisis. Seven children were waiting for a bed on Wednesday.

The bill cleared the Senate fairly easily but faced a challenge from Republicans on the House Health, Human Services, and Elderly Affairs committee, which voted along party lines to recommend the full House kill it.

During a committee meeting in March, Rep. Erica Layon, a Derry Republican, said she was concerned the bill would allow people to “self-declare” a qualifying medical emergency and get coverage without pre-approval from an insurance company. 

“I greatly appreciate the intent of this bill,” Layon said during the committee meeting. “I think that if we’re going to be talking about self-declared mental health crises, it (opens) the door for a very, very, very large provision of services. I think that that’s just too much, and I can’t support it.”

Rep. Lucy Weber, a Walpole Democrat, disagreed with Layon’s interpretation during the committee discussion. 

“The only thing that’s changing if we adopt this…is where the delivery of service occurs,” she said. “It happens closer to the patient and not in a hospital. So for that reason, I don’t think this is likely to result in claims for, ‘I’m feeling a little anxious today.’”

The new law, which the full House passed in June on a voice vote, also creates a commission to explore sustainable ways to pay for behavioral health crisis programs.