Attorney General Neronha leads a multistate effort to protect mental health and substance use disorder care

PROVIDENCE, R.I. – Attorney General Peter F. Neronha led a coalition of attorneys general from across the nation in filing an amicus brief in the United States Court of Appeals for the Ninth Circuit seeking to protect mental health and substance abuse disorder care in their states.

The case addresses whether insurers may deny access to mental health and substance use disorder services based on internal guidelines that are inconsistent with generally accepted standards of care and state law, and calls for a full rehearing of the case en banc.

The filing follows upon the Ninth Circuit’s panel decision overturning the trial court’s decision in Wit v. United Behavioral Health (UBH), a landmark case that found the nation’s largest managed behavioral health care company wrongfully denied mental health and addiction treatment coverage to tens of thousands of subscribers. Most recently, a panel of the Ninth Circuit issued a decision that, while recognizing UBH’s duty to follow state law, threatened the ability of insurance beneficiaries to have their claims considered under the correct standard. In overturning substantial portions of the district court’s judgment, the panel decision creates barriers to access to mental illness and substance use disorder treatment, and unduly restricts behavioral health coverage for State residents.

In their brief, the states again argue in support of a petition for a full court review of the panel decision to remedy significant errors that endanger the delivery of mental health care and substance use disorder services which are required to be provided by law. 

“For decades, Rhode Island has recognized that treatment for mental health and substance use disorders should be covered adequately by an individual’s insurance coverage plan,” said Attorney General Peter F. Neronha. “We must continue to ensure adequate coverage for Rhode Islanders seeking critical behavioral health treatment. Today, I am proud to stand with colleagues from around the country to fight against what is a significant risk to how individuals in our respective state’s will receive that essential care.”

In 2019, the trial court in Wit found that UBH had violated state laws by using its own, more restrictive criteria to wrongfully deny mental health and addiction treatment coverage to tens of thousands of subscribers.

In March 2022, that ruling was overturned, setting a dangerous precedent for how treatment can be covered nationwide. In May 2022, Rhode Island helped lead an amicus brief filing calling for clarification of the ruling to ensure the decision did not unintentionally violate patients’ access to care. The filing today continues to assert these interests.

Joining Attorney General Neronha in filing the brief are Attorneys General from Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Michigan, Minnesota, New Jersey, New York, Nevada, Oregon, Vermont, Washington, and the District of Columbia.

Protecting mental health and substance use disorder care in Rhode Island

Rhode Island has long been at the forefront of ensuring those living with mental health and substance use disorders receive adequate insurance coverage for treatment. In 1994, Rhode Island’s General Assembly passed legislation requiring any group or individual health plan to provide coverage for treatment of mental health and substance use disorders. In 2015, recognizing the premier expertise of the American Society of Addiction Medicine (ASAM) for those battling substance use disorders, the General Assembly amended the law to require that payors “rely upon the criteria of the American Society of Addiction Medicine when developing coverage for levels of care for substance use disorder treatment.”

Rhode Island has also been steadfast in its commitment to holding insurers accountable for violating such laws. Previously, the Office of the Health Insurance Commissioner (OHIC) ordered United Healthcare (parent company of UBH) to pay a state fine of $350,000 in addition to a $2.85 million contribution to benefit mental health parity infrastructure and behavioral health-focused community programs. OHIC further ordered UBH to pay a $100,000 administrative penalty in a consent order related to the same conduct covered in Wit.

From 2011 to 2020 Rhode Island saw a 108% increase in annual overdose fatalities. Rhode Island’s annual accidental drug overdoses increased from 190 in 2011 to 397 in 2020. Furthermore, according to Kaiser Family Foundation, more than 59% of Rhode Island residents with mild mental illness and 38.3% of Rhode Islander residents with severe mental illness did not receive treatment in 2019.


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