Please support this bill to require insurance companies to apply generally accepted standards of care when making medical necessity review determinations for mental health, substance use disorders, addiction, and behavioral health. An insurance company should not be making medical decisions, each individual's medical provider should be making that decision. When an insurance company does not apply generally accepted standards of care when making medical necessity review determinations, patients do not get the medical care that (1) their medical provider recommends for them and (2) that the patient needs for their health.

I am writing to express my strong support for House Bill 2738, which seeks to ensure that health insurance plans in Virginia provide comprehensive coverage for mental health and substance use disorder treatment. As someone deeply invested in the well-being of individuals in our community, I believe this bill is a critical step toward addressing the ongoing mental health crisis and underserved members in our state. HB2738 requires insurance providers to cover mental health and substance use disorder services under the same medical necessity standards used for other health conditions. This ensures that individuals receive timely and appropriate care based on clinically accepted practices, rather than arbitrary or restrictive insurance policies. Additionally, the bill mandates parity between mental health/substance use disorder benefits and medical/surgical benefits, aligning with the federal Mental Health Parity and Addiction Equity Act . As a provider of Applied Behavior Analysis (ABA) services through Blue Ridge Autism Care, I have witnessed firsthand how delays and denials in mental health treatment can have devastating consequences. Many individuals in our area struggle to access necessary care due to insurance barriers, and HB2738 would provide much-needed relief by ensuring fair and standardized coverage. Mental health conditions and substance use disorders are treatable, but only if individuals can access the services they need without unnecessary delays or denials. I urge you to support HB2738 to strengthen Virginia’s mental health system and provide critical protections for those in need. Thank you for your time and consideration. I look forward to your support for this important legislation.

Please pass this. As a provider of individuals with IDD and other mental health diagnosis (bi-polar, schizophrenia, etc.), treatment works and should not be hassle to get coverage for. Thank you, Dr. Robin Moyher

Comments Document

Authorization denials for ABA therapy contradict the generally accepted standards of care.

There are so many families who find barriers in seeking the care and education that their children with disabilities require. We pay high insurance bills but when it comes time to apply this money to a specific disability the insurance companies don't want to pay for services. This hurts the families and the providers of these services. The providers have to make a reasonable living for the work they do, but many cannot afford to provide services at the rate the insurance companies want to pay. Please hold the insurance companies accountable so that our children of Virginia can receive the services that they need. Thank you

Hello! I am respectfully urging members of the house to pass this bill to provide coverage for desperately needed mental health services for the patients and families that I serve. Children and adults who are able to access our services can have life changing results from evidence-based therapies. I am only asking that you consider this as if your own family member needed life-saving treatment. Would this not be the same coverage you would want for them? If so, then please pass this bill!

Comments Document

Please see attached written testimonial on behalf of myself and my company

Dear Representatives, Please support HB2738. Many Americans are in need of care for behavioral and mental health, substance abuse, and addiction issues. Please support the removal of additional barriers for these very real medical concerns which require generally accepted standards of care. As a practitioner of Applied Behavior Analysis, I can speak to the positive treatment outcomes which benefit individuals, families, and communities when individuals in need receive much-needed quality services like ours. Thank you , Delegates Sickles and Torian for championing this bill.

Members of Labor and Commerce sub-committee, I'm writing on behalf of Capital ABA, an-home behavioral healthcare agency that has served Virginia families for nearly 15 years, asking you to vote in support of HB2738. It is all too common for commercial health insurances to impose extraneous hurdles to utilization management decisions, at minimum delaying service provision, and at worst denying medically necessary services all together. Requiring insurance companies use generally accepted standards of care when making healthcare utilization decisions will improve patient access to medically necessary services. Thank you,

I am writing in support of this bill as a person, parent, and provider of services for individuals impacted by mental health issues. This bill will hold insurance companies accountable for contributing to the solution by providing proper treatment to those who need services.

Please support this bill to help families and children who desperately need services and are often denied services based on non-relevant criteria set by insurance companies. These families need these critical services.

My name is Tyler Williamson and I am the CEO of FACT (Families of Autism Coming Together). We are a nonprofit serving 400+ kids and adults with autism in Hampton Roads. I am writing in strong support of HB2738 to require insurance companies to apply generally accepted standards of care when making medical necessity review determinations for mental health, substance use disorders, addiction and behavioral health. In addition to being CEO of FACT, I am also the older brother of an amazing autistic adult named Brian Williamson who lives in Chesapeake but does have some significant behavioral issues. I strongly encourage to you support this bill and allow medical and mental health professionals, and not the self-interested insurance companies, to be the ones to determine what is medically necessary for those dealing with various mental health issues. Many autistic individuals have significant behavioral health and mentals health needs and issues. These needs are going unmet and programs to support them are being closed because the insurance companies are denying their claims. The insurance companies, who have a clear monetary bias to rule against providing help, should not be allowed to unilaterally determine when these services are needed. That should be left to medical professionals and reflected in the generally accepted standards of care. Please support HB2738 and help families and individuals get the important services they need, when they need them, to help prevent tragedies and these issues from becoming worse. Our government needs to start to being proactive, not reactive, when it comes to mental health issues and this will end up saving the system money in the long run. Thanks Tyler

Comments Document

I have attached comments in support of HB 2738 from the Council of Autism Service Providers.

Delegates, On behalf of the Behavioral Health Providers Coalition, which represents seven of the largest behavioral health professional associations across the state, I urge you to pass HB2738. This legislation is critical to ensuring that individuals with mental health and substance use disorders receive the care they need, based on evidence-based standards rather than insurer-defined criteria. In September 2024, our organization conducted a statewide survey, gathering over 300 responses from behavioral health providers in just three weeks. The results highlighted a troubling trend: insurance denials are among the leading causes of harm to patients. For individuals struggling with mental health and substance use disorders, such denials significantly increase the risk of suicide and other adverse outcomes. Historically, mental health and substance use disorders have been stigmatized, leading to systemic inequities in treatment access and coverage. HB2738 aims to address this disparity by strengthening Virginia’s parity law and providing critical protections for individuals with these conditions. Current law allows insurers to use proprietary, profit-driven criteria to determine whether treatment is covered. This practice undermines the goal of parity and jeopardizes patient outcomes. Data from the Virginia Bureau of Insurance’s 2024 report further underscores the disparities. In 2023, 5 categories of denials were measured. Mental health emergency care claims were denied 4.9% more frequently than medical/surgical claims. Substance use disorder claims faced an even starker disparity, with denial rates 13.4% higher than those for medical/surgical benefits. For office visits, denials for MH were 1% higher and SUD claims 17.6% higher. Across the 5 measured categories, substance use denials exceeded medical/surgical denials in every category. When these denials were appealed through external review, 55.6% of mental health and substance use disorder claims were overturned, compared to 48.8% for medical/surgical claims. Additionally 52.6% of the complaints received related to substance use disorder benefits were related to utilization management review. 22.6% of the complaints for mental health were related to access to care compared to 10.1% for medical/surgical. These figures make it clear that insurers are not applying fair or consistent standards when determining coverage. HB2738 offers a straightforward solution: it requires insurers to use generally accepted standards of care when determining coverage for mental health and substance use disorders. These standards, developed by professionals in the field, ensure that decisions are based on evidence and clinical best practices rather than financial incentives. This bill does not impose new or unreasonable burdens on insurers. Instead, it holds them accountable to the standards they should already be meeting from both a parity and ethical standpoint. Passing HB2738 will save lives, improve health outcomes, and help dismantle the longstanding inequities in mental health and substance use treatment. I urge you to support this bill and take a vital step toward ensuring that all Virginians can access the care they need and deserve. Sincerely, Rebecca Kaderli Chair Virginia Behavioral Health Providers Coalition BOI report: https://rga.lis.virginia.gov/Published/2024/RD712/PDF

Please support HB2738 so that Virginians in need of mental health care can receive it. Right now, insurance companies deny care that has been recommended to Virginians by their healthcare providers by using medical necessity criteria that are more strict than generally accepted standards of care. These more strict guidelines only serve to create barriers to needed care for Virginians while increasing profits for the insurance companies. Decisions about what level of care is needed for a person should be made by the treating provider and the patient following accepted standards of care - NOT by reviewers who are unfamiliar with the case, uninvolved in the treatment process, and using guidelines that do not align with accepted standards of care.