I am pleased to announce exciting news about developments in the District of Columbia, regarding protections for the confidentiality of patients in mental health treatment and their right to a fair, professionally competent (external) independent peer review when they appeal denials of their claims for insurance reimbursement.
These landmark achievements were put into law as part of new amendments to the D.C. Patient's Bill of Rights Law. These amendments were developed by the D.C. Ombudsman's Advisory Council (DCOAC) and its Clinical Subcommittee, of which APsaA member Danille Drake and I are members. It was in our capacity as members of the DCOAC that we were able to contribute to this law as it pertains to patients in mental health treatment.
As is widely known, mental health professionals are deeply concerned about intrusions by insurance company claims reviewers that threaten the confidentiality of psychotherapeutic treatments. In addition, colleagues repeatedly report experiences in which psychodynamic psychotherapy and psychoanalysis are reviewed by individuals who seem not to understand the basic concepts of these treatments and appear to be hostile to the very idea of in-depth, psychotherapy.
We made a series of recommendations that pertain to these problems. Our recommendations were accepted into the final proposed amendments to the Patient's Bill of Rights Law. These amendments were then passed by the D.C. Council, signed by the mayor and then approved by Congress. (All laws passed in D.C. must also be approved by Congress.)
These amendments provide a more appropriate pathway for appeal when an insurance company denies authorization for reimbursement of treatment expenses. The insurance companies are required to follow the appeals process described below.
Among the many excellent points in this legislation are the following:
The protections by the Mental Health Information Act of DC (1978, 1979) (MHIA) were reaffirmed specifically in this newly passed law. The MHIA is well known to be an excellent law protecting patient confidentiality by limiting the type of information that may be disclosed to an insurance company for routine claims review with patient authorization. The MHIA also stipulates that a confidential independent review by a mental health professional could be requested if more information than the MHIA permits for routine claims review was needed to approve a claim.
The amendments include a statement that if during a review of the claim by the insurance company, either the patient and/or psychotherapist consider that the questions being asked by the insurance company are posing unacceptable confidentiality issues, then the review by the insurance company stops and the case is referred for external, independent review. (“External review” means a review that is conducted outside the insurance company's domain; reviews conducted by the insurance company are called “internal reviews.”)
Further safeguards were written into the law regarding the external review.
The confidentiality of the external review must be at the same, or stricter, level of confidentiality as is required for the treatment that is to be reviewed.
The external reviewers must be true peers of the therapist whose work is being reviewed; that is, the external reviewers must have equal or greater training and experience in the specific form of treatment being reviewed as does the therapist whose work is being reviewed.
Also, the external reviewer is not permitted to have any relationship with the insurer or its subsidiaries that could create a conflict of interest.
This new law at the present time applies to treatments conducted in the District of Columbia, except for those that are based on national governmental insurance programs, such as Medicare, military health insurance plans, and federal employee plans. However, D.C. has a tradition of model legislation, particularly in regard to patient confidentiality, which has been a standard for the nation. For example, the American Psychiatric Association adopted the standards as set forth in the D.C.'s MHIA (referred to above) for the APA Minimum Necessary Guidelines, which were created to help psychiatrists use the HIPAA Privacy Rule to protect patient confidentiality.
In turn, the APA Minimum Necessary Guidelines were cited as a possible national model for patient confidentiality when the United States Department of Health and Human Services commissioned a study to determine the kinds of information that might be shared between psychotherapists and managed care organizations under the HIPAA privacy rule.
Further, in the Surgeon General's 1999 Statement on Mental Health, the New Jersey Confidentiality Statute for patients of psychologists, a virtual clone of the D.C. MHIA, was specifically recommended as a model for the nation.
Barry J. Landau, M.D., is training and supervising analyst at Baltimore Washington Institute for Psychoanalysis; clinical professor of psychiatry at George Washington University and Children's Hospital, Washington, D.C.; in private practice in child, adult, and adolescent psychiatry and psychoanalysis.
I hope a way can be found to use the new amendments to the Patient's Bill of Rights in D.C. as a basis for expanding the rights of patients to confidential mental health treatment, and fair, professionally competent and confidential independent reviews when insurance companies request reviews of treatments that would threaten the confidentiality of mental health treatments.