Policy Priorities

Our policy priority on Reimbursement Rates and Rate Setting focuses on ensuring fair, transparent, and adequate payment structures that sustain high-quality mental health care access for all. This includes:

• RAE and Commercial Plan Rate Setting: Advocating for equitable reimbursement rates from Regional Accountable Entities (RAEs) and commercial insurers to close gaps that limit provider participation and patient access.

• Contract Disparities: Addressing unequal contract terms that create financial instability and restrict service availability, especially for smaller and community-based providers.

• Rate Setting and Spending Transparency: Pushing for clear, public reporting on how rates are determined and how funds are allocated to foster accountability and informed policy decisions.

• Raising Family and Group Therapy Rates: Supporting increased reimbursement for family and group therapy sessions, recognizing their critical role in holistic mental health treatment and long-term recovery.

• Medicaid Fee-For-Service (FFS) Psych Testing Rates: Working to raise Medicaid FFS rates for psychological testing, ensuring providers can offer comprehensive assessments without financial loss. Although not all providers perform this service, the downstream effect for Medicaid members with ASD and any associated services can be detrimental if not addressed because initial assessments are required for Members to qualify for critical services.

These priorities are top of mind because inadequate or opaque reimbursement systems threaten the sustainability of mental health services, limit provider networks, and ultimately reduce access to essential care for vulnerable populations. By advocating for fair rates and transparency, we aim to build a stronger, more equitable mental health system that meets the diverse needs of our communities.

Our focus on Parity Violations targets the enforcement and strengthening of laws that require mental health and substance use disorder benefits to be treated equally to physical health care coverage. This includes:

• Identifying and Addressing Discriminatory Practices: Highlighting instances where insurers impose stricter limits, higher costs, or more burdensome authorization requirements for mental health services compared to medical care.

• Improving Compliance and Oversight: Advocating for stronger regulatory oversight to ensure insurers follow parity laws, including timely investigations and meaningful penalties for violations.

• Enhancing Transparency: Calling for clear reporting from insurers on how mental health benefits are managed versus physical health benefits to detect disparities early.

• Supporting Consumer Protections: Empowering individuals with resources and advocacy to challenge unfair denials or restrictions on mental health coverage.

• Closing Loopholes: Working to eliminate gaps in parity laws that allow insurers to circumvent equal coverage through narrow definitions or limited provider networks.

Parity violations undermine access to necessary mental health care by creating financial and administrative barriers that do not exist for physical health treatment. Ensuring true parity is essential to dismantling stigma, improving treatment outcomes, and promoting equitable health care for all. This remains a critical priority because without enforcement, parity laws risk becoming ineffective promises rather than real protections.

Our priority on Reducing Administrative Burden and Cost aims to streamline processes so providers can focus more on delivering care and less on paperwork. Key areas include:

• No Prior Authorization (No PAR) Success: We celebrate the victory in maintaining the no prior authorization policy by not repealing SB22-156, which has significantly reduced delays and barriers to timely mental health treatment.

• Addressing Ongoing Administrative Challenges: We actively identify other policies and practices that create unnecessary paperwork, slow reimbursement, or increase costs, and advocate for practical solutions to minimize these burdens.

• Proactive Problem-Solving: When new administrative obstacles arise, we engage with policymakers, insurers, and providers to develop collaborative, efficient fixes that keep mental health care accessible and sustainable.

• Upcoming Batch Insurance Eligibility Verification Tool: We are preparing for the rollout of a robust, compliant, state-of-the-art new tool that will allow batch verification of insurance eligibility for both Medicaid and commercial plans. This innovation promises to save time and reduce errors, with discounted access for MHANCO members to support provider efficiency.

Reducing administrative hurdles is essential to keeping mental health services affordable, accessible, and focused on patient care rather than paperwork. By championing these efforts, we help create a system that works better for providers and the communities they serve.

Our Workforce Development priority is dedicated to building a strong, diverse mental health workforce by supporting clear, accessible educational and licensure pathways across a wide range of roles. This includes:

• Qualified Behavioral Health Associates (QBHA): The Qualified Behavioral Health Associate (QBHA) role was established under Senate Bill 22-181 (SB22-181), which is a recent Colorado legislative effort focused on expanding the behavioral health workforce and creating new pathways for entry-level mental health professionals. The bill was enacted in 2022 and sets the foundation for training, certification, and integration of QBHAs into the mental health system to increase service capacity and support community-based care. We advocate for robust training, certification, and integration of QBHAs to meet growing community needs.

• Bachelor’s Level and Intern Pathways: Promoting educational programs and internship opportunities that prepare individuals at the bachelor’s level for entry into mental health careers, ensuring early career support and skill development.

• Pre-Licensure Support: Facilitating accessible, affordable pathways for mental health professionals in training, including supervision and practical experience requirements, to ease the transition to full licensure.

• Licensure for All Mental Health Professions: Advocating for streamlined, equitable licensure processes across disciplines—such as counseling, social work, psychology, addiction counseling, and marriage and family therapy—to reduce barriers and expand the pool of qualified providers.

Strengthening workforce development is crucial to meeting the rising demand for mental health services. By supporting these pathways, we help create a sustainable, well-prepared workforce ready to provide compassionate, high-quality care to our communities.

Support for Substance Use Disorder providers and Serious Persistent Mental Illness. IOP, PHP and Inpatient,