The White House puts insurance companies on alert for mental health care

The Biden administration on Tuesday announced new proposed rules to bolster legislation that would require insurance companies to cover mental health benefits to the same degree as medical and surgical benefits, as an administration official cited a stark lack of access for Americans to mental health care.

The Mental Health and Addiction Parity Act (MHPAEA), passed in 2008, prevented large group health plans from enacting “yearly or lifetime dollar limits” on mental health benefits.

Fifteen years later, the Biden administration lamented that access to mental health services remains limited.

“We know that treatment works, which is why access to mental health providers is so critical and vital to the well-being of our families,” White House domestic policy adviser Neera Tanden said at a news briefing.

“In 2020, less than half of Americans with mental health needs are receiving much-needed mental health care,” Tanden said. And many Americans struggle to get coverage for this care. It’s not supposed to be this way.”

Under the proposed rules, health plans would be required to make changes if they are found to be providing “inadequate access” to mental health services. Deficiencies will be identified through analyzes that look to see if companies are failing to meet legal requirements.

However, insurers have not previously been found to perform these analyzes as accurately as the federal government hopes.

The Departments of Labor, Treasury, and Health and Human Services reported to Congress

In 2022, 40 percent of insurers requested an extension of time when asked to provide comparative analyzes of the limits they place on mental health benefits, such as pre-authorization requirements.

Given this high percentage, [Employee Benefits Security Administration] The report finds that many plans and issuers were deficient in their legal obligation to conduct and document the necessary analyses.

MHPAEA violations include insurance companies that do not offer out-of-network providers or inpatient benefits for mental health or substance abuse despite providing those benefits for medical and surgical services.

A company is also in violation if it charges higher fees for mental health services, imposes extensive pre-authorization requirements, or fails to disclose criteria for why benefits are denied.

Corrective actions that companies are expected to take if they are found to be inadequate include adding more mental health professionals to their networks and reducing the amount of red tape in obtaining care.

The proposed rules would also include specifications about what health plans can and cannot do, explicitly stating that companies cannot use “more restrictive prior authorization, other medical management techniques, or narrower networks” in order to limit access to mental health care.

The final change being proposed by the Biden administration would close a loophole under the original Department of Public Health and Poor legislation that did not require health plans for state and local government employees to comply with federal law.

By codifying changes to the MHPAEA passed by Congress, the White House has estimated that 200 more health plans and 90,000 consumers will be affected.

Once the proposed rules are published in the Federal Register, there will be a 60-day comment period for the public.

When asked how the White House plans to enforce these new rules, given that previous legislation has been routinely ignored, senior administration officials said they plan to report noncompliance to Congress as well as raise public education among consumers about how their health plans are legally obligated to cover mental health care.

Officials did not disclose any plans to penalize health insurance companies that fail to comply. Without disclosing a strict timeline, an administration official said the rules would be finalized in the “near future.”