BCBSRI levels behaviorial health copays with primary care, lifts approval rule

PROVIDENCE – Blue Cross & Blue Shield of Rhode Island is making behavioral health doctor visit copays the same cost as primary care and lifting approval requirements for in-network behavioral health services, part of the company’s effort to improve access to behavioral health services for members.

The changes are also intended to help address the state’s behavioral health crisis including mental illness and substance use disorder.

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According to the Truven Health Analytics report, commissioned by the state in 2014, individuals in Rhode Island are more likely to report unmet need for behavioral health care services than adults in any other New England state. In 2011, 7 percent of Rhode Island adults aged 18 and older reported an unmet mental health need, according to the report.

“Rhode Islanders should have access to the right level of every type of care, including behavioral health care, at the right time in the right place. We are committed to developing sustainable programs to improve behavioral health outcomes,” said BCBSRI President and CEO Kim Keck.

Effective Jan. 1, 2019, upon plan renewal, all BCBSRI insured plans will provide coverage for all mental health and substance use disorder office visits, including medication-assisted treatment, at a copayment consistent with primary care office visits. Previously, the copayment for behavioral health services had been consistent with specialist visit copays, which are often higher than primary care copays.

Starting on Aug. 1, BCBSRI will no longer require prior approval for any in-network mental health or substance use disorder services. Out-of-network services will still be subject to review.

Recently, BCBSRI partnered with the Addiction Services Center at Roger Williams Medical Center to deliver medication-assisted treatment to Rhode Islanders struggling with opioid use disorder. The program aims to provide evidence-based patient care by working to ensure timely, reliable access to clinical treatment and comprehensive services that focus on patients building recovery capital and improving their health outcomes. Additionally, BCBSRI recently announced its support of Bradley Hospital’s Mindful Teen Program, an innovative effort that promotes alternatives to inpatient hospitalization for children and teens facing mental illness.

“The behavioral health care system can be difficult to navigate, leaving many unsure of where to go when they need care,” said Dr. Matt Collins, vice president of clinical integration at BCBSRI. “These new policies help remove barriers to care and improve health outcomes for our members, especially after they leave inpatient treatment. We look forward to continued collaboration with the provider community as we explore more ways to improve the behavioral health care delivery system to enable a better experience, better outcomes and more cost-effective care for Rhode Islanders.”

Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.