The Proposed Rule Highlights That Insured Individuals Are More Than Twice As Likely To Go Out-of-Network for Mental Health Care Than for Physical Health Care.
By Stacy M. Brown
Originally appeared in NNPA
To help ensure better mental health care access for millions of Americans, President Joe Biden has unveiled a new proposed rule to strengthen mental and physical health parity requirements.
The rule seeks to bridge the gap between mental and physical health care benefits, a bipartisan priority for almost 15 years.
The Mental Health Parity and Addiction Equity Act (MHPAEA) was a landmark law enacted in 2008, calling for equal provision of mental health care benefits by health plans compared to physical health care benefits.
However, despite bipartisan efforts, the White House said many Americans still face challenges in finding and affording the mental health care they need.
According to a Fact Sheet, studies show that less than half of adults with any mental illness received mental health care in 2020, and only a tiny fraction of those with a substance use disorder received treatment.
“A common issue individuals face with private health coverage is the difficulty in finding an in-network mental health provider,” White House officials wrote.
“Many people are forced to seek care out-of-network, leading to significantly higher costs or even deferring care altogether.”
The proposed rule highlights that insured individuals are more than twice as likely to go out-of-network for mental health care than for physical health care.
In response to these challenges, the White House said Biden’s comprehensive national strategy aims to transform how mental health is understood, accessed, and treated across healthcare settings.
The 150 million Americans with private health insurance will have better access to mental health benefits thanks to the newly proposed rule, which builds on MHPAEA’s objectives.
The key provisions of the proposed rule include:
1. Requiring Health Plans to Provide Adequate Access: Health plans will be required to conduct meaningful comparative analyses to ensure that mental health and substance use benefits are not more restrictive than medical benefits. This includes evaluating provider networks, out-of-network payment rates, and prior authorization requirements. Plans failing to meet these requirements will have to improve access to mental health care to comply with the law.
2. Setting Clear Guidelines for Health Plans: The rule will provide specific examples to make it clear that health plans cannot use restrictive prior authorization or narrower networks for mental health and substance use disorder benefits compared to medical benefits.
3. Closing Existing Loopholes: The proposed rule will require non-federal governmental health plans to comply with MHPAEA, closing a previous loophole. Over 200 additional health plans will be impacted, providing crucial protections to 90,000 consumers.
The White House said the administration expects the rule to increase mental health and substance use care utilization and ensure comparable payment for mental health care professionals.
Officials believe this could also serve as an incentive for more people to join the mental health workforce.
According to the White House, the Biden administration has been actively addressing the mental health care crisis through various measures, including expanding access to services in Medicare and enhancing crisis response.
The recent investment of nearly $1 billion in strengthening the 9-8-8 suicide and crisis lifeline further demonstrates the commitment to improving mental health care, officials stated.