We, the undersigned mental health professionals, are writing to emphasize the critical role of reimbursement in achieving true parity for mental health care. As therapists dedicated to serving our communities, we witness daily the barriers that inadequate insurance reimbursement creates for clients seeking care. The current disparity in reimbursement rates is the number one reason many therapists do not accept insurance, leaving consumers struggling to access their commercial insurance benefits for mental health services. This results in long wait times, limited provider options, and, ultimately, untreated mental health conditions.

The federal Parity Rule of 2024, released by the Biden administration, reinforces that
reimbursement rates are a fundamental component of parity and should be included in Kentucky's oversight. The rule mandates that insurers evaluate their nonquantitative treatment limitations (NQTLs) to ensure they do not impose greater restrictions on mental health services than on physical health services. Specifically, it highlights:

● Methods for determining out-of-network reimbursement rates as an NQTL that must be assessed for parity compliance.

● Network composition standards, which can include reimbursement rate
determinations, as an NQTL that must be evaluated.

This means that insurers’ rate-setting practices are subject to parity scrutiny, and if mental health reimbursement rates are found to be unfairly restrictive compared to physical health rates, they must be corrected. Additionally, 45 CFR 146.136(c)(4)(v)(A) authorizes state insurance departments to intervene and prohibit insurers from imposing an NQTL (including biased reimbursement rate determinations) until the violation is resolved.

Given this clear federal guidance, we urge the Kentucky Department of Insurance to take decisive action in ensuring that reimbursement rates for mental health professionals meet parity standards. Specifically, we request that DOI:

1. Conduct a thorough review of reimbursement rates for mental health providers in Kentucky and compare them to physical health reimbursement rates.

2. Ensure that insurers are held accountable for parity compliance in their rate-setting methodologies.

3. Prohibit insurers from maintaining NQTL violations related to unfair reimbursement practices, as permitted under federal regulations.

4. Require transparency in reimbursement methodologies to prevent inequitable
rate-setting.

5. Establish clear deadlines and public reporting mechanisms for the completion of
reimbursement rate evaluations to ensure accountability and build trust with
stakeholders.

We also encourage DOI to examine how the New York Department of Insurance has
embraced proactive parity enforcement as a model for ensuring compliance. While Kentucky’s laws may differ, New York’s approach demonstrates how strong DOI oversight can improve reimbursement fairness and consumer access to care.

Additionally, we urge the DOI to work with Kentucky lawmakers to strengthen enforcement mechanisms that ensure compliance with federal parity laws. Rep. Lisa Willner and Rep. Kim Moser are already working toward solutions that promote greater parity enforcement, and DOI's collaboration will be critical in ensuring meaningful progress.

Mental health parity is not just about coverage—it is about real access to care. Without fair reimbursement rates, Kentucky residents are left with insurance in name only, unable to access the services they need. We stand ready to support DOI efforts to enforce parity and ensure that all Kentuckians can receive the mental health care they deserve.

We appreciate your attention to this matter and look forward to your response.

Sincerely,

The Mental Health Insurance Reform Task Force