Bill Would Require Emergency Rooms To Adopt Mental Health Discharge Plans

A separate bill from Rep. Alissa Keny-Guyer would require CCOs and insurers to cover a behavioral health assessment in a crisis as well as its treatment recommendations.

Rep. Alissa Keny-Guyer and Sen. Lew Frederick, both Portland Democrats, are back again this year to close additional gaps in the state’s mental health system.

Two years ago, they passed House Bill 2023, which required hospitals to develop a plan for discharging patients from a behavioral health crisis, including linking patients and a supportive friend or family member with a way to seek outpatient mental healthcare.

But the bill only applies to patients admitted to the hospital -- not those who are merely observed in the emergency room.

This year’s House Bill 3090 would address that discrepancy, requiring similar protocols for ER patients in the midst of behavioral health crises.

Keny-Guyer said the bill would broaden a list of policies that the Oregon Association of Hospitals and Health Systems helped craft in a work group that put HB 2023 into practice. She said it would be especially needed in smaller, rural hospitals, which are less likely to have a psychiatric ward or officially admit patients.

“It’s heartbreaking when you walk out and there’s nowhere to go,” said Rep. Jodi Hack, R-Salem.

A separate bill, House Bill 3091, would require coordinated care organizations and private health plans to cover a behavioral health assessment and the services recommended by a behavioral health clinician, a descriptor that includes psychiatrists, psychologists and social workers.

Chris Bouneff, the executive director of NAMI-Oregon, said health insurers and hospitals still don’t provide the same parity in treating a mental health issue as they do a physical health issue. NAMI is an alliance of families and people affected by mental illness.

“Just as no one would question the tests patients receive when they present in ERs with chest pains, insurance carriers, including coordinated care organizations, should not routinely question the medical necessity of a behavioral health assessment during a behavioral health crisis,” Bouneff wrote in his testimony.

Karen Meadows, whose daughter committed suicide, said her daughter had showed up several times to the emergency room, but instead of taking her seriously and linking her with appropriate care, hospitals alerted the family about her need to stop abusing the emergency room.

Rep. Bill Kennemer, R-Canby, a retired psychologist, expressed his frustration at the state’s glacial progress improving the mental health system: “We’re going to try to legislate it 1/64th of an inch at a time.”

The hospital association supported both bills, while insurers such as PacificSource and Moda Health expressed tentative support, but felt there could be issues with unlicensed providers conducting the assessments.

Reach Chris at [email protected].

Comments

 

Rep. Keny-Guyer is spot on with her recognition of the need for this legislation and the special needs of mental health patients being seen in rural hospitals that do not have an inpatient psychiatric unit.  As a community psychiatric provider in a solo private practice, I am continually frustrated by the stories I hear from clients who have presented to the local ER in crisis. Not only do they relate experiences of feeling stigmatized and dismissed, but there is no effort made by ER staff to communicate with the outpatient provider, so I do not even know my client has been to the ER unless the patient or their family notify me. Another very real problem is the tendency of ER staff to minimize or ignore the mental health issues if there is any illicit drug use or criminal behavior involved in the crisis.  Recently there was an incident that even the local paper described as attempted "suicide by cop."  That person was sent to jail from the ER, with no mental health referral!   I plan to contact my state representatives with encouragement to support HB 3090 and HB 3091.  I hope other readers will do the same! 

Julie Ryder