Despite having parity laws in place, Americans are still more likely to pay out of pocket for mental health services than physical health services. This disparity means many patients are less likely to get the care they need, even if they have insurance.
In an effort to encourage better compliance by health plans, the Biden Administration in early September released new requirements for self-evaluations of insurers’ service offerings and payment structures.
Self-Assessment Specifics
The final rules, issued collectively by the Departments of Health and Human Services, Labor and the Treasury, require insurers to check their “provider networks, how much they pay out-of-network providers, and how often they require – and deny – prior authorizations.”
By assessing these items, plans will be able to self-identity opportunities to come into compliance with the law, with an end goal of improving their systems so that patients are not unduly restricted from accessing mental health care services.
If a plan does not meet the required number of providers in a certain region, for example, it can self-correct by adding more to its network in that area. That may be easier said than done, according to health plans, who say existing networking requirements are unattainable amid the shortage of providers.
A 2022 report shows plans have been “falling short of providing parity in mental health and substance-use disorder benefits, at a time when those benefits are needed like never before.” Federal officials say enforcement of mental health parity laws is a top priority, with focus on compliance assistance.
A Time of Great Need
One in ten Americans will deal with a mental health or substance use challenge this year, and many won’t access help when they do. Experts point to both patient-level barriers, such as cost and shame, as well as provider-level barriers, like low reimbursement rates, as interfering with care.
As the country continues to grapple with an ongoing mental health and substance use disorder crisis, there’s never been a more important time to ensure equitable access to mental health services. The new rules prove the Biden-Harris Administration remains committed to breaking down as many barriers as possible, even when that means standing up to insurers.
