The Biden administration is hoping to make it easier for insured Americans to access mental health services.
In a proposed rule expected to be announced Tuesday, the administration will force health insurance companies to offer parity between their physical and mental health coverage. The proposed rule will make it clear, according to an administration official, that access to in-network providers must be equal between mental and physical health practitioners. The rule also clarifies what health plan policies can and cannot do, such as equalizing rates with physical health providers.
"Health plans must use similar factors in setting out-of-network payment rates for mental health providers as they do for medical providers. For example, they can't use more restrictive prior authorization or narrow networks and make it harder for people to access mental health benefits and make it much harder to access those benefits than medical benefits," White House domestic policy adviser Neera Tanden told reporters on a call previewing the proposed rule.
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The rule, which must go through a 60-day public comment period, will also make insurers conduct an analysis examining where shortfalls exist between mental health and medical benefits.
The Mental Health Parity and Addiction Equity Act, which was enacted in 2008, required health insurance companies to eliminate differences in coverage and cost for mental and physical health. Insurers, however, found ways to circumvent the requirements such as offering low reimbursement rates and excessive audits. Patients have found accessing mental health care more difficult than accessing care for physical ailments.
"We've learned that insurers are evading the mandate of the law. Insurers make it difficult to access mental health coverage in-network, and then consumers are often forced to seek care out-of-network at significantly higher cost and pay out of pocket or — and this is also a real challenge — they defer care altogether," Tanden explained.
Finding a mental health care provider in America is no simple task. And it's made worse by a large swath (45%) of psychiatrists not accepting health insurance, according to 2014 data published in the Journal of the American Medical Association.
With the new rule, the administration believes it will bring more providers in-network, thereby increasing access and availability of mental health providers to 150 million Americans.
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A senior administration official said that would mean plans would need to raise reimbursement rates and increase the number of in-network providers offered.
In America, 1 in 5 adults experienced a mental illness in 2021, according to the Department of Health and Human Services, while the Centers for Disease Control and Prevention found 2 in 5 adults reported symptoms of anxiety and depression.
Even before the pandemic, when mental health hit a crescendo, patients seeking care for mental health were five times more likely to go out of network compared to when seeking physical health services, according to the National Association for Behavioral Healthcare.
Once the rule is finalized, it is unclear when patients would feel the benefit. But a senior administration official said they see it as an urgent issue to bring the industry into compliance. The rule allows the Department of Labor to correct the inconsistencies through voluntary action or bring lawsuits on behalf of the individuals involved.
Earlier this year, the Biden administration announced new funding for the 988 suicide and crisis lifeline, as well as funding to increase school-based mental health counselors.
A survey by Ipsos and the National Alliance on Mental Illness(NAMI) conducted in June found the majority of Americans were still unfamiliar with the hotline.
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