GUIDE for Testimony Letters for HB 2455

 

PLEASE FORWARD YOUR LETTER DIRECTLY TO THE EMAILS BELOW BY MONDAY, January 30 no later than 10 am. The closer to this date/time the better as its close to the hearing time and will have more impact.

If you would like us to review your letter and give feedback (this is not required we are just willing to provide feedback if it helps you feel more confident) send it to me no later than Friday at 5 pm to tiffany@healthalliescounseling.com and I will get it back to you by Sunday evening.
 

Hi Providers!

 

Thanks for being willing to write a letter to support yourself, our profession, and our clients.  Keep in mind the Legislature is meant to be a place where all Oregonians can speak up for what they think will make Oregon a better place.  You are doing that.

 

To write a letter of testimony, you will write one letter and email it to all the Committee members by Monday morning. The committee members are listed at the end of this document.  BUT, if one of the members of the Committee is also your district Representative, please write a special letter to them and mention you are in their district.  That always carries more weight.    You can find who your representative is by going here:  https://www.house.gov/representatives/find-your-representative
 

Start the letter with: Chair Nosse and Members of the House Committee of Behavioral Health and Health Care: and then go on with the body of your letter.

In your first sentences, introduce yourself with your name, your license type, what kind of practice you are engaged in and the town or area you live in.  If you are part of a group or individual practice, please clarify that.  Mention how long you have been a therapist.  If you are in a group practice, it may be helpful to mention how many clients your practice serves in a month or year.

 

Ask the Committee to pass HB 2455. 

 

Go over the Talking Points (attached) and choose one or more, but not all, to focus on.  Use the language of the Talking Points as a guide, but use your own language, please.   Share about how you have been affected by audits either directly or through what you have heard in the community.  If you have considered closing your practice or stopping to take certain insurance, please mention that. If you have heard about other therapists either closing their practices or stopping taking insurance from particular insurers, please mention that.  If you had to hire an attorney  and had to pay for their services to deal with a required recoupment, please mention that.

 

Please remember that the thing that will get the most support is that these audits are limiting access to care by driving providers out of business, leading providers to stop working with certain insurers, or discouraging providers from starting a practice.  That is the primary issue for Legislators, so try to get in a statement of concern about access to care.  I am sorry to say that our incomes are not their primary concern.

 

Ask the Committee members to support HB 2455.  Thank them for the opportunity to let them know about this important issue. 

 

Try to keep your letter to one page if possible. 

 

Here are the email addresses for the House Health Care Committee:

 

Rep. Rob Nosse, Chair. (D)

Rep.RobNosse@oregonlegislature.gov

 

Rep. Christine Goodwin, Vice-Chair (R)

Rep.ChristineGoodwin@oregonlegislature.gov

 

Rep. Travis Nelson, Vice-Chair (D)

Rep.TravisNelson@oregonlegislature.gov

 

Rep. Ben Bowman (D)

Rep.BenBowman@oregonlegislature.gov

 

Rep. Charlie Conrad (R)                                                                            

Rep.CharlieConrad@oregonlegislature.gov

 

Rep. Maxine Dexter (D)

Rep.MaxineDexter@oregonlegislature.gov

 

Rep. Ed Diehl. (R)

Rep.EdDiehl@oregonlegislature.gov

 

Rep. Cyrus Javadi (R)

Rep.CyrusJavadi@oregonlegislature.gov

 

Rep. Lily Morgan (R).  

Rep.LilyMorgan@oregonlegislature.gov

 

Rep. Hai Pham. (D)

Rep.HaiPham@oregonlegislature.gov

 

Rep. Thuy Tran. (D) 

rep.ThuyTran@oregonlegislature.gov

 

 

I am attaching talking points for HB 2455. 

 

Thanks again for getting involved.  We could not do this without you.  Together we can make our professions more secure. 

 

 

Larry Conner MA LPC

OMHPPAC Legislative Chair

 

 

 

Talking points

 

The problem: In recent years, insurers and CCOs have greatly increased the number of their audits of mental health claims and the size of required repayments from mental health providers.  These refunds, commonly referred to as “recoupments,” range from $5-10K up to $200K.  Mental health providers do not have the profit margins to be able to pay back those large amounts. Also, often mental health providers are so afraid of the damage done by audits that they choose not to do business with insurance companies at all.   At a time when Oregon is seeking to increase access to mental health care, these audits are having negative effects on access to care.  

 

•Oregon statute allows insurer and CCO audits to go back 30 months making the recoupments potentially very large. 

- HB 2455 limits the amount of time an audit of mental health claims can go back to 12 months.  That will reduce the size of required recoupments. 

 

•It is difficult to avoid audits because even though documentation requirements vary with each carrier, insurers and CCOs are not required to provide written directions to providers to clearly explain how to successfully document services in order to pass audits.

- HB 2455 will require each insurer or CCO to provide clear directions to each mental health provider submitting mental health claims, defining exactly what must be included in their documentation to avoid recoupment.  This will reduce the overall number of recoupments in audits. 

 

•The vast majority of required recoupments are based on simple clerical errors found in audits.

- HB 2455 follows current statute for Pharmacists that disallows recoupments for simple clerical errors, and it can allow for providers to correct such errors.  

 

 

•Insurers and CCOs drive up the size of required recoupments by auditing only a small fraction of claims and then issuing large recoupment demands based on “statistical sampling” processes that extrapolate a guess at an overall error percentage, not an actual claims reviewed.          

            - HB 2455 will require auditors to examine each claim individually so that large recoupments based on a few errors will be avoided.

 

 

•Insurers and CCOs often hire third party auditors who are paid a portion of the recoupments in an attempt to encourage them to find more errors, thus driving up the amount of recoupments.

            - HB 2455 will disallow insurers and CCOs from incentivizing large recoupments.

 

 

•Insurers and CCOs regularly drag out the audit process to one or more years, leaving providers under an incredible amount of stress as they are trying to serve their clients, and deeply fearful about the continuation of their businesses for an unreasonable length of time.  If the required recoupment is large, providers have to hire attorneys to challenge the results of the audit which further extends the process and is very expensive.    

• HB 2455 will require audits to be completed within 6 months.     

 

 

•When providers initiate care with clients, in the process of preauthorization, the insurer or CCO can require the provider to demonstrate there is medical necessity for the treatment to continue.  After appropriate documentation is submitted by the provider, the insurer or CCO approves that medical necessity determination, and the mental health care is allowed to continue.  However, during audits that medical necessity determination can be retroactively denied months or years later, and the entire length of service to that client can be rejected. 

-HB 2455 would not allow insurers or CCOs to reject a determination of medical necessity once it has been agreed upon, and it would require that all auditors of mental health claims must be trained as mental health professionals. 

 

 

•Access to mental health care is suffering because of the unjust and threatening audit process, because each year more providers will go out of business, avoid working with certain insurers/CCOs, avoid going into private practice, or simply leave Oregon to practice elsewhere.  Oregon needs more mental health providers to be available to provide care, not less. 

- HB 2455 will make the audit process more transparent, just, and rare which will make providers more willing to stay on provider panels and to remain in practice in Oregon to provide care to our most vulnerable citizens.