by President Joe Biden speaks during an event in the East Room of the White House in Washington, DC, at … [+]
The Biden administration says it will remove barriers to access and lower out-of-pocket costs for mental health and substance abuse care. Last month, the administration issued final rules that impose new requirements on health care plans that it claims will “improve and strengthen access to mental health care for 175 million Americans with private health insurance.”
The Mental Health Parity and Addiction Equity Act is a federal law passed and signed into law in 2008. The intent of the bill is to prevent health insurers that provide coverage for mental health or substance abuse care from imposing more restrictions on these benefits than they would. do other medical benefits.
In practice this is often not the case. A Milliman report published in 2019 found increasing disparities in provider payments and network adequacy between physical and mental health care, despite the 2008 MHPAE law aimed at achieving equity.
And a Gallup poll released in May of this year found that most Americans believe mental health care is worse cared for than physical health, partly due to higher out-of-pocket costs and other barriers to access, such as narrower networks of providers.
According to the Biden administration, despite the enactment of the 2008 law, too many Americans are still struggling to find and afford the care they need. This is especially true when patients must go outside the network to obtain medically necessary care.
Studies cited by the government show that fewer than 50% of adults with mental illness had access to care in 2020, while nearly 70% of children cannot receive covered treatment.
The administration’s final rules strengthen existing law with a new set of rules intended to ensure that insurance plans make changes when they are determined to provide “insufficient access to mental health and substance abuse care.” For this purpose, plans must collect and evaluate data, report to the federal government, and, if necessary, take reasonable action to address material disparities in access to mental health and substance abuse care compared to medical or surgical benefits.
In addition, the rules expressly do not allow a more restrictive use of utilization management tools, such as prior authorization, than would apply to other medical benefits, such as surgical procedures.
Another problem facing the mental health field is that providers are under-reimbursed by insurers, which can lead to a shortage of qualified therapists and higher out-of-pocket costs for patients because some providers only accept cash payments. Given the hurdles, both financial and otherwise, patients sometimes give up on care.
It is not entirely clear how much the final rules will contribute to improving reimbursement rates. The federal government is asking insurers for clarification on out-of-network reimbursement rates for mental health providers. In this context, health plans must conduct comparative analyzes to evaluate standards regarding who is in the provider’s network, what out-of-network reimbursement rates apply, and what the prior authorization requirements are. But it is uncertain how more transparency will subsequently result in better rewards for providers.
For decades, health insurers have erected barriers that make it more difficult for insured patients to access mental health care. Former First Lady Rosalynn Carter was an advocate for mental health awareness and treatment. Nearly fifty years ago, she began her campaign to remove the stigma of mental health and place it on an equal footing with physical health. Carter paved the way for reforms, including the landmark 2008 Mental Health Equity Act. Despite this, physical health is still generally better insured than mental health. The Biden administration’s final rules are intended to clarify and strengthen the 2008 law’s legal protections for patients with mental illness or substance use disorders.
