H.B. 71 Health Provider Directory and Access Amendments: transcript

Yes. Uh, th Thank you, Mr. Chair. I know you have a, a a a very busy agenda, so I'm going to try to be brief. Um, let me just start out by telling you what the problem is. We're trying to correct with this bill. Our legislative auditor has done a fantastic job of doing a number of, uh, Uh, Be audits of beha, the behavioral health system. They did an audit this past year where they found that 69% of providers in commercial directories, uh, were not accepting new patients, had the wrong phone number, were listed at the wrong location, or did not accept insurance. So if you just think about this, if you, uh, purchased an airline ticket and about 70% of the time you showed up at the gate and they said, oh, sorry, uh, we're not taking, uh, that that flight's not gonna go today, that would be extremely frustrating. Uh, per nami The, uh, average delay from symptom onset to diagnosis and treatment for somebody with mental illness in America is 11 years. When you get to that point of, uh, seeking help, if the insurance you paid for 70% of the time is not available, that's extremely frustrating. I've experienced this personally in my own life with a family member. We never ended up getting outpatient care. It ended up going to the emergency room and then an inpatient stay, which is far more costly to the insurance companies. Far more traumatic to the, the patient and their families. So, um, I, during this bill, I felt like a marriage counselor, and I don't, I'm not gonna become a marriage counselor. Um, I've had two sides. The providers and the insurers both pointing fingers at each other saying it's their fault. And I've concluded that there is absolutely shared responsibility. So we've tried to strike a balance here between, uh, on both sides. Uh, saying that, um, if insurers, uh, repeatedly ask, uh, for a provider to update, and they don't, they notify the insurance, uh, commission who will send a letter out to the, the member, excuse me, the provider saying, really, you need to respond to this. We'll track and see how often that happens. If ultimately, uh, somebody can't find, uh, help, they call up their insurer and say, please help me find somebody, um, then it's their responsibility, even if they have to do a single case agreement, um, if, if the directories are working properly, no side has issues with, with this bill. And that's the goal. So I'm just, for sake of time, I'm gonna stop right there and just give care achievers from inseparable who's been working with me on this bill. Just a very brief, uh, comment about the bill, and then I'll conclude my presentation.

Thank you representative. My name is Kara Sheever, and I'm the Vice President of Coverage policy at Inseparable to Non-Profit. Founded on the belief in the knowledge that our mental health is inseparable from our physical health. Um, this bill is incredibly important and I applaud, uh, the Utah legislature for taking this this topic on ahead of many other states. What this bill does is make sure that people in Utah who spend a lot of money on their insurance every single month, hundreds and hundreds, and hundreds of dollars on their premiums, that when they're paying for an insurance product, they're able to use that to get the care that they need. As the representative said, seven in 10 providers are not actually taking new patients. And when you're in crisis, the inability to find, uh, care for yourself or your child can be the difference of life and death. And so what this bill does is not only make sure that the set standards to make sure that this bill or that these networks are accurate, but if and when they're not, it allows families and individuals to go out of network and not pay more to do. So. It, it streamlines access, it, uh, adds accountability, and then also sets a framework for future, uh, provider directory accuracy and, um, access standards in the state. Um, this bill is doing some incredible work ahead of other states and, um, couldn't be more, uh, uh, pleased and grateful for the leadership.

Uh, the last thing I'll just say is this was a unanimous interim bill, but since then I have made numerous changes to the bill to try to assange the concerns on both sides. Um, suffice it to say there's, uh, still little, well, we'll find out a little bit of agitation on both sides, which I think would indicate I've struck a good compromise. The last thing that Bill does is create a working group with a, an idea that both sides are really enthused about, but it's a little bit more complicated. That'll give us the interim to work through it. That concludes my presentation, Mr. Chair.

Okay. I don't know what asage means, so I don't know if I can support the bill. Just kidding. So, um, I'm gonna make a motion, or just if you want, I just wanna make a motion to substitute the bill. Okay. So I'm gonna make a motion as we discussed before, 'cause you discussed the third sub. So my motion is to adopt third sub of HB 71.

Uh, thank you, Mr. Chair. I, I wanted to, when, uh, good representative mentioned, excuse me, a single case exemption exception, I lit off a light bulb for me because I know that of multiple cases with folks seeking mental health care, where this truly has been a lifesaver, and this is just even, you know, local in your everyday existence. And I think that it is a built in valve, uh, to allow for better care for people sometimes in complex and complicated situations. Um, as with anything in health, there are nuances and you want the right person with the, the right person to be helping someone take care of their issues. And so I think that this seems to me to be very well thought out. And, and I don't know, can I use the word massage? He used a swash. I don't if it's gonna get too weird, I won't. Uh, but I, it feels to me like it's, it's, they've really worked through the pieces to, to get to what we ultimately want, and that is for people to be able to get the care that they need. So I, I just wanted to put that in the dialogue.

Thank you. The sponsor. Mr. Chair talked about the, the balance in trying to strike a good balance between two, and I guess we might have a little public comment, but just further, further dialogue concern with, on one hand, the claims, well, insurance is gonna go up. On the other hand, this is a genuine need that we have. And how do you address it? Could you just flesh this out on the left hand a little bit? My left hand a little bit more the, the perceived impact of the insurance?

Yes. Th Thank you, Senator. So, um, I was reading an email from Becker's Behavioral Health that, uh, really made a, made a point that hit home the need for this bill. Ever since COVID, there's been a dramatic increase in people seeking treatment for, for behavioral health issues. And what I read, and I'm not accusing any insurers in the room today or in Utah doing this, this was just an article in the, the, the press that said nationally, uh, there have been some insurers. The belief is that they are purposely limiting access to behavioral health to control the spend. You do that by having a narrow network, by having ghost providers. And so, um, I don't think he may say that publicly, but I believe that, I firmly believe that's happening, at least at a national basis. So the bottom line is, is I can't say whether this would increase spend or not, but what I can say is somebody's paying for insurance, they better be able to get what they're paying for because we pay a lot. And knowing that use suicide is the leading cause of death for children in Utah. The last thing I want is somebody to lose a child or have 'em to have to go inpatient because they couldn't find an outpatient provider. So the bottom line is we're paying for it, we should get what we're paying for. It also strikes me, Mr. Chair, that there's potentially an analogy here. We often look at early intervention in needs and, and how a dollar spent now saves, uh, so much down the road. I mean, even on insurance, I'm wondering if, uh, there's any data on that. I suspect perhaps not, but there is a theory there that I think that might be helpful to consider as well. Thank you.

Hello. Good morning, chair and committee members. Please Pull your mic right up close. Sorry. No, it's just the way it's designed. Thank you. Um, my name is Elizabeth McKnight and I am speaking on behalf of the League of Women Voters Today. Um, the league holds that every user, uh, I'm sorry, every US resident should have access to affordable and quality behavioral healthcare that achieves parity with physical healthcare. HB 71 gets to the heart of one of Utah's most frustrating barriers to access mental healthcare. We support HB 71 because it promises to reduce the time it takes people in crisis to find the life-saving healthcare providers they need. HB 71 would make all those involved in the business of mental healthcare delivery, accountable for removing misinformation and outdated records and provider directories that impede getting the right care expeditiously. This bill also charters a work group to envision a new and better inventory and search tool for the future that can service both insurance-based and cash-based providers actively accepting patients in the state. This new tool would effectively increase the pool of available providers and decrease time to the start of a definitive mental health treatment. One suggestion, um, adding a patient or family member to that database work group would let the developers hear directly from those best acquainted with the inadequacies of the current directories. Um, for the sake of our family members who pay for mental health insurance, but still can't get timely and effective mental health care because the directories thwart them, please support this bill.

Thank you. Thank you, Mr. Chair. Michelle McCumber with the Utah Medical Association. We support this bill. We appreciate Representative Eliason working with us on it. Um, we had a lot of concerns with the original draft, um, but you know, and it is one side saying the other side's doing it, and the other side's saying the other side's doing it. So we appreciate the work group and we do appreciate Representative Eliason always, um, thoughtfully thinking through how to expand access and services in mental health. So we appreciate, um, working with him when would, uh, support and ask you to pass this bill out. Thank you. Okay.

Thank you. Thank you Mr. Chair. Mike Sontag with the Utah Health Insurance Association. Um, we're here to express some concerns that we have. This bill by well-intentioned this bill will increase costs for small businesses that this legisl to regulate and seek to support. The requirements in this bill impose new operational compliance costs on commercial plans, and those costs do not disappear. They're ultimately born by employers and employees through higher premium. Historically, Utah's maintained a clear and important precedent when a policy change is appropriate for the, is that it? No, No, that's, you have another 15 seconds. This bill breaks from that precedent by explicitly exempting the state plan and directing it to avoid any financial impact by alternates business practice that creates an uneven playing field and shifts costs away from the state and onto small business in the private market. More importantly, this sets a dangerous precedent, one in which the legislature mandates new requirements, but allows the state plan to have sidestep the financial consequences. This does have an administrative burden that we must bear. Thank you.

Thank you. Good morning, Mr. Chair and committee. My name is Jessica Black and I am the legislative chair of the Utah Mental Health Counselors Association. I'm also speaking on behalf of the Behavioral Health Workforce Work Group, and I am here to, in strong support of HB 71 in my private practice. I personally see the effects of Ghost networks daily patients in crisis call providers and are constantly told that this person doesn't work here anymore. Um, they're not taking patients. And for somebody that's struggling with mental health or substance use, that could be the final straw where they just hang up and they don't try anymore. I wanna thank Representative Elison who may actually have a future in marriage counseling, um, because he did work tirelessly to, with all the stakeholders and coming to a meaningful compromise, um, this bill is a result of that compromise. Not only does this bill mandate accuracy, um, it requires the directory to be updated every 60 days, and it also enforces timely access. If a provider is not available that is on the list, they are then allowed to get a single case agreement from an out-of-network provider. By passing this, you are ensuring that that insurance card actually is the key to care and not just a piece of plastic. Thank you. Thank you.

Thank you, Mr. Chair and committee. My name's Ross Van and I'm here representing as the vice chair of the, uh, policy Review Committee under the Behavioral Health Commission. We strongly support, uh, this bill. This is very timely. I, I was the executive director of Huntsville Mental Health for 30 years, and I can tell you this is not a new problem. This has been going on for a number of years, particularly since the late eighties with the advent of managed care. So, uh, we strongly urge you to support this bill and, and this, uh, critical piece of legislation that really speaks to transparency and accountability and, and compliments to Representative Ellison for actually working this out with two different groups in a really tricky area. Thank you.

Thank you. Hello, I am Sarah s Strub. I am the legislative chair for the Utah Association for Marriage and Family Therapy. Um, we are in full support of HB 71 and also thank Representative Eliason for his collaboration on this. Uh, currently there's a significant disconnect between perceived and actual provider availability. In a recent workforce survey, we found that nearly 75% of mental health providers in Utah report having immediate openings, um, outdated provider directories make these clinicians invisible to the families who need them. I also wanna point out that the guidelines, the, um, administrative burden that was mentioned, uh, this bill actually aligns with federal standards under the No Surprises Act. And so any accountability and guidelines are already built into the federal level. So, um, we ask that you also support this bill. Thank you.

Mr. Chair, I'll go ahead and place the motion that we pass out favorably, HB 71 third sub and my Time's up again.

Uh, to con There's no comments from my motion to pass out Favor. Oh, I'm sorry. Sorry. You're moving so fast. I can't even keep up with you. It's the Senate. Um, we go slow and then it's like done. I, I wave. I wave. So I, uh, I'll speak to the, my Motion. And before we place the vote, I, I do agree this is emerging of lots of different interests. It's not easy. Uh, I think you're walking a fine line and doing a pretty darn good job. And so, uh, we'll keep you moving forward with this issue. And so the motion for us

Alright, uh, thank you Madam Chair. Uh, Madam Chair and Committee. Uh, this was an interim bill that, uh, we, we discussed, uh, fortunate at the time to have, uh, unanimous support. I am gonna be speaking to the first substitute that's available online. Um, I've been working with, uh, stakeholders, uh, from the provider community and the insurance community to make some additional adjustments to, uh, try to address some of the concerns that, uh, uh, they, they expressed. Um, just as a refresher course since, uh, we heard a number of issues during interim, uh, this bill has, its, which was a committee. Bill has its genesis with an audit done by, uh, Ola, our legislative auditor general. And they went out and sampled 180, uh, behavioral health providers from commercial insurance directories, uh, called every one of 'em to see if they could get an appointment, like if they were, you know, a patient seeking care. And they found that approximately 70%, 69% were gonna round to 70%, um, were what were entitled ghost providers, meaning they're no longer practicing at that clinic. They're no longer accepting that insurance, they're not accepting patients. Whatever the reason the, uh, person who's paid for insurance has relied on the directory, uh, finally made the call to, to, to, to get treatment. Uh, nearly 70% of the time are told, sorry, not an option. Um, so this bill seeks to address that issue. You know, keep in mind that these are individuals that are paying a lot of money for, for health insurance. One of the statistics that is so troubling in the behavioral health space is nationally, this is a stati statistic per nami. There's an 11 year delay from the time the symptoms begin to emerge in an individual, often youth, until they get a diagnosis and begin treatment. If you look at any other disease, if you have an 11 year delay between symptoms and treatment, the outcomes aren't good. The sooner we intervene, the better the outcome, the lower the cost for insurers. Uh, the, the, the less demand on an overtax system from a provider network. In the case of individuals with a serious mental illness, the less gray matter that gets destroyed in their brain, that sometimes can never be, um, rectified. So I don't think anybody disagrees that, uh, when somebody is ready to seek help, which again is already, uh, too long over a decade, that if they paid for insurance, that they should be able to get that insurance. Can you imagine if you showed up for a, a, a, a flight with an airline and they had oversold it by 70%? And so the vast majority of people who'd booked the ticket were told, sorry, we sold more seats. Maybe a crazy example. But in this case, people are paying for something that they're often unable to, to access. So, uh, the bill, um, does a a number of things. Um, as I visited with kind of the interested parties, um, they all had valid points as to why we have inaccuracies. Uh, the insurers said we send out thousands of letters, probably tens of thousands of letters, and they're often not returned. So the accuracy of our directories is highly dependent upon providers timely responding to our requests and giving accurate information. Um, um, so what the bill would do is, um, it puts some incentives in place, and I've reduced this from, uh, basically kind of, uh, licensure to the language we've added as a citation. And I've also added, after a pattern of repeated, um, kind of problems, would the ins, uh, carriers, health insurance carriers then notify Doppel? And unlike the earlier version of potentially taking action against their license, this is a citation. So we've kind of watered it down from, to use a driving analogy, taking, suspending somebody's driver's license to issuing them a, a speeding ticket again. And this is only after repeated, um, uh, a pattern of repeated issues. Uh, the bill also says that if an individual, uh, does contact, or they're using the provider directory to find, uh, a, you know, a specialist, um, somebody to treat a certain condition, they're unable to find somebody due to either being a ghost provider or just network inadequacy, then the insurer needs to, uh, contract on a single case agreement to find that person, uh, appropriate clinician for the issue that they are wishing to address. Um, it's currently written as, uh, a negotiation, uh, willing to continue discussions. I'm very reticent to state specifically what the dollar amount should be. I think that becomes a slippery slope if we are dictating what reimbursement rates should be. I do like the, you know, Adam Smith's invisible hand in terms of the market mechanism to parties coming together to find a equal point. My hope would be that's extremely rare, is the directory's accuracy dramatically improves with a bill like this, and that that need becomes, uh, less and less of an issue. Um, one thing that I added to the bill that's at the very end that I'm actually really enthused about, and this was something that both the, uh, insurers and the clinicians all seem to support, but I think it's, um, instead of rushing it, I think it's something that takes a little bit more time. It would just require, um, the state to convene, uh, a work group to study the feasibility of kind of expanding upon Doppels database that currently lists all clinicians and their license status to partner with the insurance companies, where we could have one statewide kind of master directory. They can still have their own directories, but we'd have one master directory that's tied to licensure of every behavioral health clinician in the state that an individual could click on them and see, oh, what insurance do they take? What county are they located in? Are they accepting new patients? What conditions do they specialize in? Do they do virtual? Do they in person, um, maybe color it green, taking new patients yellow call for availability, red, sorry, close to new patients. Um, an individual could say, oh, I've got this type of insurance. I'm looking for somebody in Wayne County that treats this type of condition. Ideally, they also do virtual appointments. They could search it and see what's available. Some other benefits of this is, as we've seen from another legislative audit, uh, a tremendous number of behavioral conditions have moved to cash pay only. There's no directory for cash pay only clinicians. This would be an avenue that every clinician could be listed. And for those that are desperate or don't have insurance, would at least see who's available, um, on a cash pay basis, take new patients. It would also help the insurers that if a, a covered member comes to 'em and says, I can't find anybody to say treat my daughter's eating disorder, but it looks like there's five clinicians in my county that are cash pay, can you please work with them on a single case agreement to, you know, get my child help? Um, one of the best things about it is, and this is what the working group has to sort through, is maybe on, I say quarterly basis. Doppel would send out an email to the clinician saying, Hey, the insurers have said this is who you contract with. Can you just confirm if this is correct? And then we can quit sending the thousands of letters through snail mail, sorry, post office. Um, and then there'll be a one-stop shop for clinicians. There could be APIs back and forth between the providers, uh, the insurers, uh, provider database and the DOPPEL database providers confirming if the information's correct, that gets pushed back to the insurers, insurers initially providing information as providers in their network, um, whether they're virtual in person, et cetera. Um, but this would simply convene a, a group to come back to this committee by November with recommendations on the feasibility of doing something like that. Um, but that part I think is, uh, would be in addition to this, we still need the components in this bill to address those issues. One of the changes in the substitute is pushing off the changes, um, for the provider directories until July 1st, excuse me, from July 1st until January 1st to give them more time, because oftentimes they operate on a calendar basis. Um, the single case agreement clause would still be effective July 1st. Um, I'll just sum up, um, by reading, um, Juab, just covering a couple points in terms of, uh, why, why this is important. Um, ghost providers are a real thing. I've nicknamed this Bill Ghostbusters bill, um, because again, we, we have a problem, um, both in Utah and nationwide. We know that this is a, a problem. Um, the, the bottom line is that if patients have a delay in getting access, that can result in deteriorating conditions, uh, increased risk for, uh, suicide, and they're not getting what they're paying for if they are ready to seek care and they can't find that care. Um, so, uh, I think it's a, it's a very important policy that's very, um, sometimes it's hard to explain bills to constituents on technical topics. This one's really simple. So many people I've talked to, including somebody today that I was working with on a technical perspective of the bill said, can I just share my family's story about trying to access care? And it's a story repeated thousands of times, and I think this is a, a sensible step in the, the right direction. So that would conclude my presentation. Madam Chair,

Oh, thank you. Uh, Madam Chair. Um, and thank you for this step in the right direction. Um, in my head, there are still a lot of questions about how it would play out, and one is this. So in the case where they can't find a provider, and now the insurer is giving them a provider, so to speak, whether it's a one at a time contract or something else, are there parameters around how that has to look? Can the insurer say, no, this provider will see you and they will, but they're a six month wait. Can they say, this provider will see you and they will, but they've got one star 'cause they are, are a really, really bad provider. I mean, are there parameters around that? I, and I know that's maybe a little bit passed even what the bill is trying to accomplish, but it is worth thinking about a little bit how sometimes those things happen.

Thank you. Um, unfortunately, we don't go that granular in the bill. I, I, I will say that in talking to both clinicians and the insurers related to this bill, everybody agrees we, we have a problem and we need to take a step in the right direction. I realize this bill doesn't solve answer every question, and those will be things that have to deal with. I, I experienced that my own self and trying to find, um, provider for a family member. And after I finally found somebody who had an opening at some point in the future, then I started reading the reviews and I'm like, I don't think we wanna go to that clinician. Sadly, the way we access care finally was through the emergency room, which too often is the case, and that's extremely expensive for insurers, traumatic for patients. And so if you have any suggestions on how to, to, to fine tune some of that, I'm happy to do that. I would hope that if an insurer keeps getting, you know, requests for single case agreements, they would say maybe it's time to broaden the network and find more reputable clinicians. Sure. Thank you. Thanks.

Thank you. Three minutes really reduces my anxiety, so I appreciate it. Sorry, I don't like the doorbell. Okay. Okay. I spoke too soon. You're Good now. Okay. Um, my name is Sarah Strub. I'm the legislative chair for the Utah Association for Marriage and Family Therapy. Um, and I own one of the largest outpatient practices in the state of Utah. Um, I wanna thank Representative Eliason for his collaboration. Um, there are many wonderful parts to this bill and we want to fully support it, but there are a few things we need changed. Uh, the substitution is an improvement, but even a citation would be disciplinary action against my license and would be public record on my license and would impact my liability insurance and would possibly still initiate my removal from an insurance panel. Um, due to the disciplinary action, professional licensure is about protecting public safety from clinical harm, not enforcing an insurance company's policies. Furthermore, there are already consequences built into our contracts with the insurance company. They can suppress our directory, they can even remove us from the panel. Um, my hope is that this isn't because the insurance companies don't want to enforce their contractual obligation with us. Um, also, I would like to note that in my nine years of private practice, I am on six different insurance panels and I've only ever heard from two of them to update my directory ever, ever. Um, so we are asking that disciplinary action of any kind be removed from the bill. We are also asking that insurers, um, the insurance companies are required to provide an automated timestamped confirmation of provider communications to mitigate penalties resulting from miscommunication failures, communication disputes. Um, furthermore, these unnecessary burdens directly contribute to the administrative strain that is already limiting patient access to providers who take insurance. Um, I have partnered with some colleagues at UVU to do a study on, um, providers who only accept cash pay, and we are at about 25% in the state of Utah. And 52% of those providers site administrative burden with insurance companies is the main reason why they don't accept insurance. Our concern is that this will further demotivate providers to take insurance and actually, um, become a barrier to treatment. So, uh, we hope for further collaboration and getting this bill to a place where it will really help Utah tons without penalizing the providers. Thank you.

Thank, thank you for those comments. I do. You, I would be super interested if you had some questions about, or some thoughts about how it could be structured so that the list actually was functional, uh, for patients, but avoided the harms that you're afraid of. Do

This bill is 85 90% there. We're just asking that the disciplinary action, the citations against our license is removed. Um, being a licensed professional Okay. Is not a protecting.

Okay. So you think the bill would still be a good bill without that part in it? It's

A great bill. Great. Okay. I just don't wanna be disciplined on my license for miscommunications. Super

Understandable. Okay, Thank you.

Thank You.

All right. Good afternoon everyone. My name is Jessica Black and I am the legislative chair for the Utah Mental Health Counselors Association. And I first, again, wanted to thank Representative Ellison for doing this bill. We very much support a lot of things in it. Um, there are just a couple of changes that we would request. Um, first of all, uh, line three 10 in the bill authorizes doppel to impose a fine, if a provider does not return an insurance company's call to update information. Um, it does say a repeated, I would also echo what Sarah said about having some kind of proof of that repeat of that repeated violation. Um, however, it's not technically doppel statutory, uh, role to impose, um, citations for clerical errors amongst two contract uh, holders. So, um, also the federal law of the No Surprises Act already addresses Ghost provider issues. Under the No Surprises Act insurance are already required to remove or suppress nonresponsive providers in their directories. Um, the law treats this as a network management issue and not a licensing issue. Um, in addition, these requirements already exist in our contracts with insurance companies. Um, insurance companies hold all the leverage when it comes to the contracts. They already, um, are able to remove a provider from the panel at any time for any reason. Pretty much, um, the government does not need to step in to enforce a private contract between two businesses. Um, to illustrate this, imagine that Representative Clancy and and rep Representative Ward get into a contract together. And, uh, you know, Clancy is trying to reach Ward and, and, and he does not respond. And then I, as the government come in and I say that Representative Clancy is choosing not to enforce his contract. And so Representative Ward, you have to pay for that. That doesn't really make sense to me. So I would hope that the insurance companies would have the burden of proof and that they would have the burden to update their spreadsheets. Um, I really do think that we need to be supporting small businesses and not protecting billion dollar companies. Thank you.

Good afternoon. I'm Jamie Brow. I'm the Director of Professional Affairs for the Utah Psychological Association. We also are very pleased with, uh, the efforts that are being taken to resolve ghost directories. Uh, for me personally, it's always been important to me to take insurance because therapy should not be a luxury product. And there are many people who can't afford a cash pay rate. And I've been concerned about ghost providers for quite a while. I also, because it works best for me to take insurance work for a large company, I don't do any of my own insurance management myself. Somebody else handles that for me. I asked my manager, I asked my clinical lead, they asked an insurance company and nobody could tell me who gets these communications on my behalf. So part of my concern is, is this lack of, um, any way to verify communication or track what's been going on. I'm very concerned that a citation could be issued against me for a communication that never came to me, and that I never saw when my good faith would have been to address anything in a timely manner, if possible. On the other hand, uh, I, we have members who have, um, who are small business owners, who have other experiences with insurance companies where they have made good faith efforts to, for example, let an insurer know that a colleague has died and should be taken off the panel and continue to get referrals for that person. For years. I've had colleagues who will, um, respond to a request for updates and information only to later get another letter saying that they never responded for us. I think it's very important that there be some level of, um, accountability on both sides to make sure that communication is documented. Any type of action that could be taken against our license has the potential to be career altering. Uh, so it would affect my liability insurance. It would affect my ability to practice under the psychology inter-jurisdictional contract compact. It would likely affect my employment as well. And so if we want to increase access to insurance, I think we need to not disincentivize providers, uh, from participating in panels. I also appreciate the item about, um, availability. Essentially, if there's not easy access to a provider that someone could, uh, look at it, um, a special arrangement for that. I am concerned that it's being defined as seven business days. And I would like to also make sure that that doesn't mean that we're going to put the administrative burden on providers to essentially be updating their availability in real time on a daily or weekly basis. I think that would certainly lend to the administrative burden that is also very common, commonly cited as a reason for psychologists not to take insurance. Thank you. Thank You.

Good afternoon. My name is Lee Ann Wrap. I am a licensed clinical social worker and the executive director for the National Association of Social Workers Colorado Chapter. Um, or sorry, Colorado and Utah Chapters. I apologize. I'm in new roles here. Um, I want to thank Representative Elias and for his work on this bill for taking this issue very seriously. This is a very real problem for, um, for both patients and providers regarding inaccurate provider directories. Um, ghost Networks harm both patients and providers here, and so we want to acknowledge that and appreciate his efforts to try and address that. One of our concerns, um, in addition to the concerns that my colleagues have already raised today in which we are agreement on, um, is also how this bill affects therapists working in group practices or on venture capital back platforms like headway and better help in these models, as was just described to you as part of a larger group practice. Clinicians also do not control communication with insurers. The platform or the practice entity itself manages insurance contracts and credentialing billing systems, portals, and directory updates. And providers often never see and don't have access to mail or other carrier notifications that are handled by that entity's credentialing office. When insurers send directory requests to these entities, many clinicians never see those either and aren't authorized by the platform to respond directly. Yet, this bill places the consequence for not responding to an insurer's request onto the individual therapist's professional license. That's disproportionate. We think insurance carriers already have enforcement tools at their disposal. Payment withholding contract termination and network removal, those already exist as part of standardized contracts. Adding licensure penalties does not improve directory accuracy. It shifts the administrative risk onto clinicians who already have the least amount of control in these settings. And we fear that this deep penalties proposed in this bill will lead to an increase in providers who decide to opt out of accepting insurance altogether, which would then further limit access to care for people across the state of Utah. Professional discipline should focus on patient safety, professional ethics, and clinical competence, not on insurance paperwork. We really strongly urge the committee to consider reasonable enforcement mechanisms that already exist for insurance carriers while keeping licensure focused on protection of the public. Thank you. Thank you.

Thank you, Madam Chair, Mike Sontag with the, uh, Utah Health Insurance Association. Um, starting from last year when Representative Elison first brought this bill for us, every iteration has gotten better and better and new ideas have come forth and made this idea better, better. In fact, he, this is a great idea to get to, and the idea that he's getting to is an electronic database, uh, to compare doctors that are receiving new patients. Some of the things he described in his bill of, with red, green and yellow lights accepting may accept, and that both insurers and providers can access at the push of a button. Um, Insurers already reach out to providers on a regular basis to ask for updated information. Many of my insurance companies ask every 30 days, hence they stack up in inboxes. Um, we also have in our contracts with providers that you've heard, they have to keep their information current or notify the insurer of any changes. However, the response rates from providers are low. One of our insurers said the response rate is less than 60%, and the information in our directories is only as good as the information that we receive from, uh, providers. And we don't want to penalize providers by taking them out of our networks because we want to keep our networks as wide as possible. So it's, it's too big of a penalty for us to enforce. It's there in the contract, but it's really rough to enforce that because then we lose a provider in our network, if that makes sense. And so, um, most of the complaints that we've heard will be addressed and handled by the last part that, uh, Representative Eliason testified he was most greatly enthused about, um, a lot of these issues on how this system would work. Um, but that doesn't, uh, does that convene in the fall? Is that the, It has to be reported by November, has to be reported on by November. So it would go through, so one of our, you know, we're still working through, so the, uh, Representative Ward brought up the, um, The swing out or the, uh, single case issue and, and what are the guardrails around that? Yeah, we've got a lot of concerns about how the guardrails around this, uh, single case issue would work. Um, because in a lot of our cases, one of our insureds, if they will just call the insurance company we have, and, and earlier reiterations of the bill required us to have an ombudsman or a person or a customer service person, um, help them get information. So they're down to seven days on helping them find an ED person. So in many cases, trying to negotiate a single case agreement, uh, would take longer than just calling the insurance companies and getting help finding an insurer that would take them on. So there's, there's a lot of things, uh, the seven day enforcement, there's a lot of things to work out, but I think this, uh, task group that reports in the fall could actually handle all of the things in the bill that we're worried about and some of the penalties that are happening that are still in the bill that we're hoping we can modify. Thank you. I have one quick question.

Oh, what, so when they reach out to the providers, it's through email, it's through a call, it's through how?

That's a good question. I defer to the providers on the Representative Barlow Representative Ward. Um, I believe it's by letter, but I believe it's also by email. So, okay.

So, so the providers that, that, that testified said that they don't get notices or haven't gotten notices, so I, there's this, There is a disconnect. There is a disconnect. So I guess I'm wondering like, where's the disconnect happening?

That's why I'm most hopeful about, uh, representative Lyon's, uh, task force that'll report in the fall because we wanna Iron both of those out so that everybody's Communication is key Communicating on that single location. Yeah. And then our enforcement mechanism is with the Insurance department and there is with Dopel, and they both have the authority to say, no, you're the problem.

Well, I just might not partially wanted to respond to your question is, and because every situation is quite different, right? We've heard from a bunch of behavioral health folks. I'm just telling my own experience. So I am employed by Ogden Clinic, so it's a multi-specialty group, but we've got probably hundreds of these contracts, um, in general, especially because each insurance company nowadays has 10 or 15 or 20 flavors. There's not just one Blues cross, there's a dozen blue crosses. So if you walked into me with a name, I, I would have no idea. I would say in general, we take most Blue Cross. That would be all I would know to tell you. Um, I, whether or not they sent, I have not to my knowledge received any of these requests myself. I hope I have staff that takes care of this. I have no, no really idea. If they did send it to me, I would never see it ever. Um, because I just have so many email inboxes of things that are just, you know, sent to me continuously at a certain point, this would be a thing that I would for sure not see. My larger administration in my office, I think runs fairly well. So I hope they would get these and take care of them. But I that, I don't really know anything about it from that perspective. Yeah,

Thank you Madam Chair. Michelle mcc, CEO of the Utah Medical Association. We, uh, represent thousands of physicians in all specialties across the state. And, uh, we do appreciate Representative Monson working, um, with us. We do appreciate his bill and the message in this bill and where we need to go with it. Our concerns are around, again, the unprofessional conduct, um, uh, penalties on physicians, um, and what was said by Dr. Ward is so true. And what was said by all of the mental health, uh, uh, groups that got up and testified. I'm not gonna repeat what they said, just say ditto to that. But I will say that, you know, this solves a small, small, maybe small part of the problem, right? We just don't have enough providers. We don't have enough physicians in Utah. We're like 44 or 45 out of the 50 states in physicians per capita. So it's a much, much bigger problem. And I, I'm not sure how much this will solve. I think it's a good bill in terms of saying, let's do one offs and see if we can find someone to do it. But, you know, the more administrative burden, and we had two bills today, our, our more administrative burden, right? The more that we place on the providers every single time, and the physicians every single time, the more they're gonna say, you know, I'm tired of it. I'm done. I'm gonna be done early. We wanna be careful. We don't wanna push him out. And so we want to do this in a way that makes sense. Um, and, and does help. And we do really appreciate Representative Eliason working with us. He is always willing to work and he has good ideas. Um, it's just how do we do that in a way that doesn't place too much burden and doesn't actually penalize, um, against their professional license. So thank you.

Maryanne Martindale, Utah Academy Family Physicians. I will be very quick 'cause a lot of, um, what I would say has already been said. Um, I had a personal experience like this. My doctor retired after about 16 years of having the same family physician. Tried to find a new one, had a also had new insurance, which through, you know, all was wrinkle. Um, the list of doctors that my insurance provided me had people on there at the clinic that I attend that have been gone for six plus years, and no one who had been new for the last two. I contacted the clinic. I mean, now this is, you know, I'm kind of the inside so I know how to ask the questions, contacted the clinic. They said, we've never even heard from that insurance. We, we, we paid that insurance. We, we go with that insurance, but we've never had a request from them contacting the insurance. They said, well, we just wait for the, for the providers to let us know. So there is a problem. Definitely. Um, I don't think this is quite there. I think the concept is great. I think we can probably get there. I do think a task force would be helpful to really actually think through this because to Michelle's point, administrative burden just keeps getting worse. Um, you walk into your clinic, you're gonna see people just exhausted and buried, and there's just not enough. You know, we don't, we have one of the lowest, um, per capita primary care providers poor per, um, a across the nation. So, I mean, it is a real problem. And, and we hope that we can get this where we need it to be, to address it, 'cause it is a real problem. Thank you.

Good afternoon, committee chairs and members. Thank you for this incredibly important conversation today about the mental health of Utahans as well as patients' access to learning.

For? I will do that. I'll, I'll switch my paragraphs up. My name is Kara Cheever. I'm Vice President of Coverage Policy at Inseparable, a national, uh, nonprofit dedicated to expanding access to mental health care. Um, it's really heartening to witness these discussions on how to best ensure that community members can get the care they need when they need it, and with the insurance coverage that they're promised. Um, I urge you to support this bill, health Provider Directory and Access Amendments, which ensures that patients in Utah have access to behavioral health care in a timely manner and will reduce their experience with Ghost Networks. Utah's office of the legislator, excuse me, the Utah's office of the legislative auditor General conducted a performance audit of the Behavioral health workforce last year. And it found that 69% of providers in Utah could be classified as ghost providers. Uh, meaning that those directories that patients rely on in times of crisis are largely inaccurate. And the providers they are promised to have served their meet their needs, um, are not there when they need it. These inaccurate provider directories, uh, result in Utahans seeking out of network care more than three times the national average, paying significantly more out of pocket for their care that their insurance is required to cover. Um, and this is from a 2024 study by RTI. While there are specific requirements in place through the No Surprises Act, um, and other state requirements, uh, there's still a, a huge issue with provider or with patients, uh, being able to get the care they need when they need it. And maybe part of the communication, um, between providers and carriers can be studied with a future work group. But in the meantime, we know that people in Utah are experiencing significant mental health crises, and we know that they need to be able to get the care when they need it with the insurance that they're promised. Um, delaying or skipping care, uh, altogether leads to significantly worse health outcomes. And when people can't get the treatment they need, they end up on the streets involved with law enforcement and emergency departments and hospitals at very high cost to taxpayers and anguish to families in their communities. Um, this help, this bill helps prevent this by ensuring that public and private insurance companies have enough providers to meet the needs of their patients and their enrollees. Thank you.

Yeah, I mean, I do, I would like to just give some time back to the sponsor to speak a little bit to the concerns that have been raised, if you would.

Uh, yes. I, I app I was wondering if as a member of the committee I could do that.

Um, I, I appreciate everybody's comments and appreciate working with all the groups on this. I, the good news is the common denominators, we have a problem and everybody wants to solve it. Um, one really important point that I think cuts through some of the concerns is that the Federal No Surprises Act requires providers to, uh, respond, um, every 90 days to these, uh, requests for insurers. So that's, that's federal law. I'm not changing that. They still have to respond. I wish the No Surprises Act would've fixed our Ghost network, uh, ghost provider issue. Clearly it hasn't. So taking, I think some of these measures steps in the bill, um, will help us address, um, the, the, the inaccuracies that still exist. Uh, someone raised the concern about seven days, um, on line 2 64. I've already changed that in the substitute to 15 days, which is half a month. I hope that would be sufficient. Um, I, I I will say that, you know, the concern that was raised here, that was new to me was they a provider may be part of a PR big practice and doesn't get these notifications. Um, I would assume that doppel upon notifying somebody of this concern would use their home address wherever they're getting the, the, the letter in the mail I, I get from my CPA license that it says it's time to renew, that they would notify him of that address. That's something I can talk with Doppel about. I don't know if that would need to be a little tweak we'd make here, but I never want anybody to experience that. And again, we moved it from the action against their license to a citation in response to this. Um, we just know that if there has to be some sort of, uh, I dunno if, I don't wanna use the term a carrot or stick to, uh, incentivize, uh, better responses to this because this is, this is a symbiotic process. If the providers aren't getting the right information, then the insurers can't update it. So that's, tho those are some of the, my thoughts on some of the questions that have RA been raised.

And Representative Ward, did you have Another, could you speak to the concern that one that was expressed here, that even a citation by itself could cause action to be taken against your license? Is that a correct way to see it, or?

Um, that's an excellent point, and that's why in the substitute I put a pattern of repeated violations. So, and again, then we downscaled it from the more of the citation, which I know still has consequences. I, I would hope Doppel in the spirit of not wanting to reduce network adequacy wouldn't take this lightly. I mean, again, a pattern, it's kind of hard to make an excuse for a pattern of repeated violations.

D does the, does the federal law itself that you cited, the No Surprises Act is, is it in our code such that if you don't follow the federal law, that that by itself constitutes unprofessional contact because you didn't follow a federal

Law? No. No. Okay. No, no. Alright, thanks. Thank You. Not that I'm aware of.

Thank you, Madam Chair. Um, just question for the sponsor. I know you've been working on this a very long time. I'm just listening to these concerns and wondering a couple of things, maybe if would it be better to resolve them before moving forward? Or even, I'm wondering if this needs to be a working group instead of being a bill. Like, maybe, maybe the working group part is what we need to focus on and solving the problems that way. I'm not sure what the answers are, but those are my questions.

Thank you. Those are excellent questions. Uh, let me answer them in reverse order. Okay. Um, it's interesting how a Bill Spurs action and in the past, even though this was an interim bill from months ago, in the past 24 hours, there's been a flurry of interest in the bill that has been public for many, many months. I get that. And we have, uh, had a meeting in the minds or a, a closer reconciliation on some of the issues in very short order, including like within the past hour. Um, I don't believe kicking this can down the road is a good answer for patients or to address the issue that Ola has brought up to us. Um, it, it, I think it clearly deserves legislative action because this is not just a problem in Utah. It's an issue across the nation. We, we, we want to, as best as we can, solve this problem. And I think that that's gonna need statutory some changes. So hence, but getting to what I'll call the promised land, that's where the working group comes in. Where I think that the, the one combined database, which is on top of the, the, the policies already in here, we still need these policies, but that central database would eliminate a lot of the burden on both sides. Um, to your other question, of course, I would defer to the will of the committee if they, uh, would like to hold the bill to, uh, work out, uh, for further changes. Um, again, it was an interim bill that I've watered down since then. I dunno if I should say watered down, but improved. Okay. Uh, I guess that depends on your perspective, but, um, that one, of course, I'm open, you know, to, to the will of the committee on that.

Yeah. A couple, um, questions, maybe a comment. Um, how many insurance entities does one provider deal with ne on average? Do, do we know? I mean, it's probably a lot. Um, I, I'm gonna give you my best guess. If you're a sole practitioner, it's, it's probably gonna be a handful If you're in a large clinic that contracts with many, many insurers, it could be almost every one of them. Um, I don't, I can't point to any data saying what the average number is, but, um, I don't, that's My best answer than probably less than a couple hundred. Yes. Um, so maybe a comment now, um, if a provider is getting this letter or email or communication, or maybe they're not getting it, um, like, like, um, chair Hall mentioned, we probably have a communication issue, um, to some extent here, if we think about the patients as well. Um, if, if a patient came in and and said, Hey, I I didn't receive that bill, I'm, I'm just not gonna pay it because I never got it. Um, you didn't send it to me. Like, it doesn't matter how you sent it, you still probably want that money. Right? So again, a communication issue that, that we're dealing with. Um, so I, I get the issue and I get the concern, um, maybe the level of, of disciplinary action on, on the license there. Um, but I do think that there has to be some kind of accountability somewhere. And I'm not sure what that looks like. So I, I guess that would be my comment.

I'm sorry, madam. I'm sure I might have jumped the gun. I was gonna make a motion to move the first substitute, so whenever you're ready.

Thank you Madam Chair. I'd like to make a motion to move first substitute house bill 71. That motion is in order. Um, would you like to speak to it? Um, well, I, I do believe that this substitute has, is the product of really good faith effort that the sponsor stated he would make when we discuss this in interim. And, um, since that's the bill we're discussing, we at a minimum need to move the first sub. Okay. And to the sponsor of the Bill that's, thank you for not letting Perfect be, become the enemy of good, which is actually a clinical principle of dialectic behavior therapy. So I support that. Awesome. Thank you.

Sorry to for one more question, and I apologize if you said this and I didn't catch it. The substitute doesn't have a fiscal note yet. It will that be markedly different or We would expect it to be the same as the underlying fiscal note. Mm-hmm.

I expect it to almost evaporate. Okay, thanks. But I'll wait for that to happen. Yeah.

Good to Know. I I, can I just say that part of it was with a quick time around turnaround some agencies that would input the fiscal note, like, well, we're gonna have to hire extra people if we have to do it this fast. Hence I created longer windows and several compartment parts of the bill. And that is, is that mainly for the working group and No, No working group shouldn't have a fiscal, well, I dunno, we'll see if the working group has a, it shouldn't have a fiscal note 'cause it's state agencies already exist to just convene stakeholders and talk through it. Great.

Thank you Madam Chair. I'd like to make a motion to pass out favorably for substitute a house bill 71 Health Plan provider directory amendments, um, and look forward to a lot of collaboration with stakeholders as we move forward through the session.

Thank you. Thank you. Um, thank you Madam Chair. I will commit that. I'll continue to have, if it does, uh, pass out of the committee favorably, I'll continue working on fine tuning. Albeit that I don't think anybody's gonna be a hundred percent happy. In an ideal world, there's no, there's no penalties for not doing something. We have a problem here. The fact that both sides are a little bit, I mean, overall supportive, but a little bit agitated makes me think that maybe we've struck a balance, but I don't think we're a hundred percent there. At a bare minimum, I think we should make sure that providers would receive a notice at their home address wherever they have listed that information is sent to. If there's going to be any sort of administrative action and maybe put a l one more step in there that they can appeal that. So it's not just, you know, oh, you're guilty, here you go. I mean, I take it very seriously. I held a license too and, you know, I wouldn't want that to be in jeopardy. And I just think that though there needs to be some sort of consequence for repeated, you know, ignoring of request to keep information accurate. So thank you. But I think it's in the best interest of patients to continue moving forward.

Thank you. Thank you Madam Chair. And I would echo your, your comments as well. I, I think that there's a sincere desire by all parties to continue to have discussion about this, but it is an issue that needs to be solved. Um, two comments and observations that a lot of, you know, some of this burden should fall on the insurance companies. I agree with that as well. And so I would, I would put a call out, you know, if there is a way to make that suggestion for, you know, to the stakeholders involved. I, I think that that's a worthy discussion, but let's, you know, if, if there's a path forward on that, let's figure out what that path forward is and make sure that all options are on the table. But, um, I just, again, I'll reiterate, I'm really grateful we had this, a long discussion about this over, in, over interim. You made, um, you address the concerns that were were brought and I've got some trepidation about it for sure. But I think that we're moving in a, in a good direction and would echo the, the testimony from the, um, the public that you've, there's a lot of good that you've done here and we have a lot of opportunity to come together to continue to fine tune. And thank you for taking this on. Thank You. Thank

Madam Reading, clerk First substitute House bill 71 Health Provider Directory and Access Amendments by Representative Stevie. Listen, this bill was heard in Health and Human Services with the vote of 11 2 1.

Uh, thank you Mr. Speaker. Motion to move substitute number two in my name.

Uh, yes. Um, this substitute, uh, should address the concerns that, uh, a number of you have asked me about, uh, with this substitute, the Utah Association of Marriage and Family Therapy, the Utah Mental Health Counselors Association, the Naso National Association, the Social Workers Utah Chapter, and the Utah Psychological Association support the bill.

Uh, thank you, Mr. Speaker. Uh, Mr. Speaker representatives. This bill has its genesis, uh, with an, uh, audit done by our, the Utah Legislative Auditor General Ola. Uh, they did a, a have done a series of beha behavioral health audits. And, uh, what they did in this particular audit, there's a, a handout, uh, that should be on your desk. It doesn't have any good pictures, like the good representative from you in a basin always has, but, uh, it has some good detail on it. Um, there's a link in the bottom to their audit on behavioral health parody. They found something very troubling. They found that of the commercial insurance directories for behavioral health providers, 68% of the providers listed in those directories are what they deemed ghost providers, meaning they are not gonna be able to get services from them because they're no longer at that practice. They don't accept the insurance. Some cases they may have passed away. So could you imagine if you booked a flight and nearly 70% of the time the airline told you, just kidding, that flight won't be an option. That wouldn't go over very well. But our auditor found that in commercial insurance directories for behavioral health providers, they were, uh, almost 70% of the time inaccurate. So we worked on this bill throughout the interim have made lots of changes trying to bring the provider community as well as the, uh, health insurance community together on this. And I think that, uh, we're Vernal very close, if not there, of resolving, uh, any of the concerns. So basically, uh, the goal is that these directories will be much more accurate. Um, the, they have to scrub them more frequently and audit them to make sure that the, the data is accurate. A component that the health insurance company said to me was an issue is getting providers to respond to their inquiries about whether or not their information was still accurate. So what the substitute does is it says that if a health insurer can't get a clinician, a provider to respond to their letters to confirm that their information's up to date, they shall notify the insurance commission who will then send, uh, uh, a letter of concern. This is not disciplinary, it's outside of doppel. So it doesn't impact their license or their liability insurance. A simple letter saying, Hey, can you please respond? We'll track these letters in the future, and hopefully that will get their attention if there's an issue there. But generally, providers want to respond. They want these directories to be accurate. Um, and so that's, that's one of the key components. Another really key component is if an individual who has purchased commercial insurance seeking treatment for a behavioral health issue for either themselves or their family, if they can't find anybody in that directory for their particular, uh, condition, then they can contact the health insurance, uh, provider and say, I can't find anybody. Please, please help me find somebody. If they can't, then that individual can say, well, I found a private provider that can provide the, the necessary treatment. And they're, the health insurer is then required to negotiate a single case agreement to make sure that the person who's paying for health insurance is getting, um, what they're, uh, what they're paying for. The, the last really important part of the bill that is to me very exciting is, is we were working on this with both groups. An idea emerged that we could have one central database in Utah that would list all providers for behavioral health, including those that only accept cash. Our auditor, uh, found out that about 20% of providers, um, our cash pay only because they said it's too difficult to work with insurance, the reimbursement rates aren't good enough, a host of reasons. So the last part of the bill says, let's just create a, a, a a, a temporary working group to bring the insurance commission doppel and the, uh, clinicians and provider health insurance providers together to look at how we could have one database that wouldn't set, uh, replace any standalone database, but would be supplemental, could have shared data back and forth with APIs that could also list cash pay providers and make it searchable for be kind of a one-stop shop. This bill, again, doesn't create that that will take a lot of stakeholder engagement, but at least this launches the process to get those discussions going. So, um, the bottom line, Mr. Speaker, is that if somebody is paying, uh, good money, uh, for health insurance, and they finally, we, we know nationally there's an 11 year delay from symptom onset to the time that somebody seeks treatment and diagnosis for a mental health issue, 11 years. If by the end of that time they finally seek treatment, they, they find, like I have, when seeking care for a family member, oh, most of these people aren't taking patients. They're not there anymore. They could end up with a lot of frustration. This bill seeks to make that process easier so customers can get what they're paying for. Uh, we can better provide better access, especially if those, if they find there's nobody that can help me in the directory, there's now an avenue for them working with their health insurer to get access. So that's basically what the bill does. Mr. Speaker, happy to answer any questions. Thank you. Thank

Thank you, Mr. Speaker with the sponsor yield.

So, Mr. Speakers, I understand that there's significant new requirements put on the health plans to make an effort that their directories are kept up to date, which I applaud. My question for the the sponsor is, if the provider does not respond to a query from the health plan trying to update their information, they get a letter from the insurance department. What happens if they don't respond to that letter and don't provide the updated information?

Uh, thank you Mr. Speaker. Uh, that's a, a very good question. Um, the, this is a step in the direction for accountability. The original version was that eventually after a repeated series of non responses, they could be sanctioned and their license can be in jeopardy. There was lots of angst over that. We don't wanna scare providers away. Um, I've heard a lot of stories going both ways where they respond. I've heard several stories of a deceased provider being in a directory for multiple years despite requests from that practice to remove them. So it's going both ways. This is a step in the, the right direction for accountability. And like I said, we are going to be, uh, working with doppel, the Insurance Commission to look at the volume of these letters. And if the next step is to put some sort of license sanction, that's a discussion we'll have to have. If the volume of these letters indicate that it's really mostly the providers, uh, we'll just say fault or responsibility for these directories being, being inaccurate. So it, it's not perfect, but it is a step in the right direction.

Thank, thank you Mr. Speaker. So I do have a little concern with this bill. There's significant requirements on the help plans to have a, a robust and accurate provider directory. I think that's great, but many times that's dependent on the providers responding and giving correct information. So it can go in the directory and there's really no enforcement or there's no consequences. The providers don't respond. They can get a letter from the insurance department, but there's no teeth. It's like getting a pocket ticket and you know, there's no fine, you just stuff your, well, I don't do it, but you could stuff it in your, uh, glove box 'cause there's no consequence. So, and I understand the, the prior version, but maybe too punitive. I just encourage the sponsor to have a little better balance here. You're gonna require timely and accurate data from the health plans. You should require the providers to provide timely and accurate responses with some teeth if they don't. Thank you.

Thank you, Mr. Speaker. I just wanted to, um, thank, um, the sponsor of this legislation for working with, um, um, NASW, the social workers on this. I jokingly told him, um, this morning, yesterday morning, I believe it was, he has every LCSW, this side of the Mississippi blowing up my phone and email, um, because they know I'm an LCSW. So I just wanted to say thank you for providing that amendment and working with them with something that they're able to work with.

Uh, thank you Mr. Speaker. Just before walking to the chamber, I was speaking with a representative from, uh, one of the largest health insurance, uh, companies in the state talking about the changes that I'd been made that was also in favor of the health insurance side of the equation. And he said, you know, this bill is maybe like a, a divorce where, uh, as good a divorce could be where both parties don't get everything they want. But it's getting to a point where, uh, both sides have had to compromise to come to a certain outcome, which I think is where we're at with this bill. The bottom line, I do want to just respond briefly to the comma that was made currently in the contract between a health insurer and a provider. If they do not respond, they can cancel their contract. So that is the most punitive form of punishment they can do. They don't want to do that, hence the tracking mechanism. So hopefully both sides will do better. So for the benefit of our citizens, they have accurate information they can rely on. Thank you Mr. Speaker.

Motion to move substitute number two in my name.

Uh, yes. Um, this substitute, uh, should address the concerns that, uh, a number of you have asked me about, uh, with this substitute, the Utah Association of Marriage and Family Therapy, the Utah Mental Health Counselors Association, the Naso National Association, the Social Workers Utah Chapter, and the Utah Psychological Association support the bill.

Uh, thank you, Mr. Speaker. Uh, Mr. Speaker representatives. This bill has its genesis, uh, with an, uh, audit done by our, the Utah Legislative Auditor General Ola. Uh, they did a, a have done a series of beha behavioral health audits. And, uh, what they did in this particular audit, there's a, a handout, uh, that should be on your desk. It doesn't have any good pictures, like the good representative from you in a basin always has, but, uh, it has some good detail on it. Um, there's a link in the bottom to their audit on behavioral health parody. They found something very troubling. They found that of the commercial insurance directories for behavioral health providers, 68% of the providers listed in those directories are what they deemed ghost providers, meaning they are not gonna be able to get services from them because they're no longer at that practice. They don't accept the insurance. Some cases they may have passed away. So could you imagine if you booked a flight and nearly 70% of the time the airline told you, just kidding, that flight won't be an option. That wouldn't go over very well. But our auditor found that in commercial insurance directories for behavioral health providers, they were, uh, almost 70% of the time inaccurate. So we worked on this bill throughout the interim have made lots of changes trying to bring the provider community as well as the, uh, health insurance community together on this. And I think that, uh, we're Vernal very close, if not there, of resolving, uh, any of the concerns. So basically, uh, the goal is that these directories will be much more accurate. Um, the, they have to scrub them more frequently and audit them to make sure that the, the data is accurate. A component that the health insurance company said to me was an issue is getting providers to respond to their inquiries about whether or not their information was still accurate. So what the substitute does is it says that if a health insurer can't get a clinician, a provider to respond to their letters to confirm that their information's up to date, they shall notify the insurance commission who will then send, uh, uh, a letter of concern. This is not disciplinary, it's outside of doppel. So it doesn't impact their license or their liability insurance. A simple letter saying, Hey, can you please respond? We'll track these letters in the future, and hopefully that will get their attention if there's an issue there. But generally, providers want to respond. They want these directories to be accurate. Um, and so that's, that's one of the key components. Another really key component is if an individual who has purchased commercial insurance seeking treatment for a behavioral health issue for either themselves or their family, if they can't find anybody in that directory for their particular, uh, condition, then they can contact the health insurance, uh, provider and say, I can't find anybody. Please, please help me find somebody. If they can't, then that individual can say, well, I found a private provider that can provide the, the necessary treatment. And they're, the health insurer is then required to negotiate a single case agreement to make sure that the person who's paying for health insurance is getting, um, what they're, uh, what they're paying for. The, the last really important part of the bill that is to me very exciting is, is we were working on this with both groups. An idea emerged that we could have one central database in Utah that would list all providers for behavioral health, including those that only accept cash. Our auditor, uh, found out that about 20% of providers, um, our cash pay only because they said it's too difficult to work with insurance, the reimbursement rates aren't good enough, a host of reasons. So the last part of the bill says, let's just create a, a, a a, a temporary working group to bring the insurance commission doppel and the, uh, clinicians and provider health insurance providers together to look at how we could have one database that wouldn't set, uh, replace any standalone database, but would be supplemental, could have shared data back and forth with APIs that could also list cash pay providers and make it searchable for be kind of a one-stop shop. This bill, again, doesn't create that that will take a lot of stakeholder engagement, but at least this launches the process to get those discussions going. So, um, the bottom line, Mr. Speaker, is that if somebody is paying, uh, good money, uh, for health insurance, and they finally, we, we know nationally there's an 11 year delay from symptom onset to the time that somebody seeks treatment and diagnosis for a mental health issue, 11 years. If by the end of that time they finally seek treatment, they, they find, like I have, when seeking care for a family member, oh, most of these people aren't taking patients. They're not there anymore. They could end up with a lot of frustration. This bill seeks to make that process easier so customers can get what they're paying for. Uh, we can better provide better access, especially if those, if they find there's nobody that can help me in the directory, there's now an avenue for them working with their health insurer to get access. So that's basically what the bill does. Mr. Speaker, happy to answer any questions. Thank you. Thank

Thank you, Mr. Speaker with the sponsor yield. Yes. Representative Monson Elon. Yes, that Representative Dunnigan. So, Mr. Speakers, I understand that there's significant new requirements put on the health plans to make an effort that their directories are kept up to date, which I applaud. My question for the the sponsor is, if the provider does not respond to a query from the health plan trying to update their information, they get a letter from the insurance department. What happens if they don't respond to that letter and don't provide the updated information?

Uh, thank you Mr. Speaker. Uh, that's a, a very good question. Um, the, this is a step in the direction for accountability. The original version was that eventually after a repeated series of non responses, they could be sanctioned and their license can be in jeopardy. There was lots of angst over that. We don't wanna scare providers away. Um, I've heard a lot of stories going both ways where they respond. I've heard several stories of a deceased provider being in a directory for multiple years despite requests from that practice to remove them. So it's going both ways. This is a step in the, the right direction for accountability. And like I said, we are going to be, uh, working with doppel, the Insurance Commission to look at the volume of these letters. And if the next step is to put some sort of license sanction, that's a discussion we'll have to have. If the volume of these letters indicate that it's really mostly the providers, uh, we'll just say fault or responsibility for these directories being, being inaccurate. So it, it's not perfect, but it is a step in the right direction.

Thank, thank you Mr. Speaker. So I do have a little concern with this bill. There's significant requirements on the help plans to have a, a robust and accurate provider directory. I think that's great, but many times that's dependent on the providers responding and giving correct information. So it can go in the directory and there's really no enforcement or there's no consequences. The providers don't respond. They can get a letter from the insurance department, but there's no teeth. It's like getting a pocket ticket and you know, there's no fine, you just stuff your, well, I don't do it, but you could stuff it in your, uh, glove box 'cause there's no consequence. So, and I understand the, the prior version, but maybe too punitive. I just encourage the sponsor to have a little better balance here. You're gonna require timely and accurate data from the health plans. You should require the providers to provide timely and accurate responses with some teeth if they don't. Thank you.

Thank you, Mr. Speaker. I just wanted to, um, thank, um, the sponsor of this legislation for working with, um, um, NASW, the social workers on this. I jokingly told him, um, this morning, yesterday morning, I believe it was, he has every LCSW, this side of the Mississippi blowing up my phone and email, um, because they know I'm an LCSW. So I just wanted to say thank you for providing that amendment and working with them with something that they're able to work with.

Uh, thank you Mr. Speaker. Just before walking to the chamber, I was speaking with a representative from, uh, one of the largest health insurance, uh, companies in the state talking about the changes that I'd been made that was also in favor of the health insurance side of the equation. And he said, you know, this bill is maybe like a, a divorce where, uh, as good a divorce could be where both parties don't get everything they want. But it's getting to a point where, uh, both sides have had to compromise to come to a certain outcome, which I think is where we're at with this bill. The bottom line, I do want to just respond briefly to the comma that was made currently in the contract between a health insurer and a provider. If they do not respond, they can cancel their contract. So that is the most punitive form of punishment they can do. They don't want to do that, hence the tracking mechanism. So hopefully both sides will do better. So for the benefit of our citizens, they have accurate information they can rely on. Thank you Mr. Speaker.

So they appear on paper to be available to patients needing care, but in actuality, they're not, not available or not actual businesses or just simply not, not there. Um, this means that the provider directories that patients rely on to find care using their insurance and in this case, uh, sometimes in a mental health crisis, are largely inaccurate and create a significant barrier to patients getting mental healthcare. So this bill requires covered insurers to help patients get behavioral health services quickly. And if an in-network provider isn't available within a specified timeframe, which is usually seven days for standard care or 24 hours for crisis, the insurer must offer a single case agreement with an out-of-network provider so the patient isn't left waiting. This will encourage the companies to keep their directories up to date and, and make sure that the, the people that the, the providers that they're publishing are actually available. So insurers under this bill ensures, must publish comprehensive provider directories and update them at least every 60 days. The bill also establishes a working group to study the feasibility and cost of statewide behavioral health provider directory. Uh, the group will then get back and make recommendations towards more comprehensive statewide data, uh, for policy makers in the public, it als. The bill also provides that Utah's insurance commissioner can adopt rules and enforce compliance with the bill's requirements, including insurer penalties for non-compliance, uh, and strengthening regulatory oversight. Um, let's see. So with that, I'll take any, take any

Well yield to Questions. Senator Cullimore, are you open? Uh, yield to questions?

Yes. Senator Buss.

Um, I see there have been a few substitutions and I just wanna make sure, um, have all of the, uh, regulations or penalties for like marriage and family therapists been removed, like the license requirements if they don't update within 14 days, like the letter against their license. Senator Cullimore?

I believe so. I was not involved in all the early negotiations.

Okay. But, but in the third substitute, I don't see anything.

I, I believe marriage and family therapists have been completely removed from the bill at this point.

Okay. Perfect. Thank you.

I'm sorry, I'm looking at the bill to ensure my answer was accurate.

I'll move that third substitute house Bill 71 be read for a third time and I will further review this bill to make sure my answer was accurate.

Yes. Uh, a motion that we table on third, third substitute house bill 71 for physical impact. A motion to table on third, third substitute house Bill 71.

Thank you Mr. President. This is a short and simple bill. It does two things. Uh, first it repeals, uh, section of the code entitled, uh, community education program, which returns ongoing funding of $6,800 to the general fund,

and body of third substitute house bill 71. Replace it with four substitute house bill 71. The intent of this substitute is to substantially reduce or eliminate the fiscal note by, rather than directing the Utah Insurance Commissioner to make rules to authorize the Utah's insurance commissioner certain pro authorizes Utah's insurance commissioner to make rules to implement certain provisions of this bill. So I think we're narrowing what, what has to be done for the insurance commission on this, which will reduce the fiscal note.

Motion to circle for substitute house bill 71. We have a motion to circle fourth substitute house bill 71.

Senator Wilson Motion Circle sponsors off the Floor. Motion to circle. All in favor say aye. Aye. Any opposed? That motion passes. The bill is circled.

Skipping from slightly to the left. Thank you Mr. President Pro Tem. We talked about this, uh, bill yesterday

of the legislative auditor general conduct conducted an audit on the state's behavioral health workforce last year finding that 69% of those providers were ghost providers. So they appear on paper to be available to patients needing care, but in fact they're not. So this means that their provider, directories that patients rely on to find care using their insurance is largely inaccurate. So this bill requires covered insurers to help patients get behavioral health services quickly. If an in network provider isn't available within a specified timeframe, the insurer must offer a single case agreement with an out-of-network provider so the patient isn't left waiting. Uh, it further requires that insurers must publish comprehensive provider directories and update them at least every 60 days. It establishes a working group to study the feasibility and cost of a statewide behavior health provider DI directory. And the Utah Insurance Commissioner can adopt rules and enforce compliance with the bill's requirements, including insurer penalties for non-compliance strength, which will strengthen regulatory oversight.

And I was told this is green now. Okay. We're seeing it red. That's what we're talking about. Yeah. Trying to figure out if it's red or green. I was told it was green, but let's, it's Scott. Scott. We good on Seven one? It's showing, I don't know why it's showing red on our red is dead.

Thank you. This is the bill I encircled not too long ago and the fiscal note ran up and we had great discussion on the bill. The bill does not require, um, it, the bill simply, um, makes insurers ensure that their health provider directories are up to par.

I will move under suspension of the rules that we pass forth. Substitute house bill 71.

of the president, Madam Marine Clerk For substitute house bill 71 Health Provider Directory and Access Amendments by Stevie. Listen.

Thank you Mr. Speaker. Motion to concur with the Senate amendments.

Uh, yes. Thank you. We work continue to working with the different stakeholders, the Insurance Commission and others to make, uh, some other, uh, minor amendments regarding the reporting provision. Uh, we're also to able to, uh, address the fiscal note. So, uh, that is the, uh, the changes that, uh, I agree with. Thank you.

We for the signature of the President, Madam Meeting Clerk