We need your help, immediately, to ensure state-regulated insurance companies are complying with federal and state law and treating physical and mental health equally.

As you know, we are working to enact the insurance reporting requirements for Jake’s Law. The insurance industry, not surprisingly, is trying to pair back the reporting requirements, especially around Non-Quantitative Treatment Limitations (NQTLs). In simplest terms, NQTLs are those benefits that are not measured financially. This would include provider networks, prescription drug benefit tiers, treatment protocols, etc. Unfortunately, this is where majority of the insurance issues arise. We need DiFi (Department of Insurance and Financial Institutions, formerly the AZ Department of Insurance) to ensure they are requiring strict reporting guidelines for NQTLs. There must be transparency.

Without strong oversight by regulators like DiFi, the promise of parity cannot be achieved, and we will continue to see vulnerable people that require mental health services denied care. As more of our loved ones are denied care, the more likely they may be to resort to suicide. This is unacceptable.

This is where you come in. If you could please send a comment by noon on March 6th to public_comments@difi.az.gov and use “MHPAEA” (Mental Health Parity and Addiction Equity Act) in the subject line. Please ask them to provide strong reporting requirements for claims denial trends, prior authorization and step therapy trends, how much more likely Arizonans are to go out-of-network for mental health/ substance abuse disorder (SUDs) treatment, approval of only lower level of care, and provider networks. We must kindly and professionally demand transparency and strong reporting requirements.

Below is my comment. If you have a personal story, please share it, they make all the difference. Thank you for all of your help. You are a blessing to us.

My Comment

Hi, my name is Denise and Jake’s Law was named after my son, Jacob Machovsky, who was lost to suicide on January 11, 2016 due to our insurance company denying him care. Unfortunately, my story is not the only one. I work with families on a regular basis that are dealing with the same issues I struggled with. I have remained engaged with what’s transpired since Jake’s Law was enacted. I’ve gone through the new rules and noticed the significant paring back of information DIFI will request of the insurance industry, specifically surrounding NQTLs. As you know, NQTLs can be difficult to identify for those not in the industry. It was the issues with NQTLs that caused the problems for our son, and that still cause so many problems for other families. It can be easy to identify a QTL like a co-pay. It is far more complex to identify a NQTL violation, which I am sure you know. I’m disappointed, but understand the complexities DIFI is facing. I really think more information, especially concerning NQTLs would provide important insight into what is happening within the Arizona insurance market, and give DIFI more insight where red flags might exist. Given that the current draft looks at the absolute bare minimum already required by the federal government since the end of 2020, it concerns me that we will not get an accurate picture of possible violations that affect many families seeking care. It would be helpful to know more about claims denial trends, prior authorization and step therapy trends, how much more likely Arizonans are to go out-of-network for mental health/SUDs treatment, approval of only lower level of care (this is exactly what happened with Jake), and provider networks. I can’t tell you how many times people tell me they struggle to find an in-network therapist or psychiatrist, especially without extraordinarily long waits, and while I know this is in part due a provider shortage, insurers should be making the same effort to beef up their mental health/SUDs network as they do for their med/surg network.

As I mentioned in my previous comments to DiFi last year, The Texas Department of Insurance (TDI) adopted regulations that require insurers to provide their non-quantitative treatment limitation (NQTL) parity compliance analyses, which is now part of MHPAEA, with the enactment of the Consolidated Appropriations Act, 20212. TDI is also requiring reporting of comparative quantitative data relating to claims, utilization review, and reimbursement rates for both behavioral and physical health.

I appreciate the ability to comment and I hope you will take this into consideration. This is about saving lives and I hope we can come to some middle ground or compromise.

With gratitude,

Denise