July 25, 2023
Thousands of Americans may receive better mental health care access under a rule proposed by the Biden administration Tuesday.
The rule, which would strengthen the Mental Health Parity and Addiction Equity Act of 2008, aims to make it easier for insured patients to access in-network mental health services, which are often difficult to obtain. According to a study cited by the White House, people with health insurance are more than twice as likely to seek pricier out-of-network care for their mental health than they are for physical health concerns. Common barriers include long wait times, low reimbursement rates and incorrect provider information on health care websites.
The rule would build on an existing requirement that health insurance companies analyze their own plans to ensure mental health and substance use benefits are just as accessible as their physical health services. Companies would be required to more specifically study their provider networks, how much they pay out-of-network providers, how often prior authorization is required for care and how often prior authorization is denied — and make changes to any identified disparities.
The rule also would clearly outline scenarios in which insurance companies cannot use prior authorization or other "medical management techniques" to restrict mental health care access. Insurers often require prior authorization, a stipulation that doctors obtain the company's approval before administering certain care, for procedures like MRIs or CT scans. But government research has found that it is often harder to get approval for mental health services, like inpatient hospital stays, than it is for medical or surgical care.
Lastly, the rule would require state and local government health plans to comply with the MHPAEA. Previously, only federal health care plans were subject to its regulations. By closing this loophole, the Biden administration says it will extend protections to more than 200 plans and 90,000 people.
"We've learned that insurers are evading the mandate of law," Neera Tanden, the Biden administration's domestic policy advisor, said in a press call. "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 this is also a real challenge — they defer care altogether."
If health insurance companies fail to comply with the rule, they could be subject to fines, a Biden administration official told Politico.
In Pennsylvania, the MHPAEA currently applies to employer-provided health care plans, individual and small group plans offered through the Affordable Care Act, some Medicaid plans and the Children's Health Insurance Program. New Jersey requires health insurers to adhere to the requirements of MHPAEA and to provide coverage for mental health and substance use disorders under the same terms as any other illness.
In a press conference Tuesday, Biden argued the need for better health care access amid the ongoing youth mental health crisis and grief brought on by the COVID-19 pandemic. While praising the MHPAEA for lowering copays, he argued "we're still not where we need to be."
"I don't know what the difference between breaking your arm and having a mental breakdown is," Biden said. "It's health. There's no distinction.
"Mental health care is health care. It's essential to people's well-being, and their ability to live a full and productive life. To find joy, to find purpose. To take care of themselves and their loved ones. It's about dignity."
The proposed rule is subject to a 60-day public comment period before it can go into effect, Reuters reports.
Cigna did not immediately respond to requests for comment on how the rule might impact access for their members, while United Healthcare declined to comment. Rodrigo Cerda, chief medical officer and senior vice president of health services at Independence Blue Cross, said in a statement:
"At Independence Blue Cross, we are focused on a whole-person approach to health that looks at all the factors that can affect a person’s well-being. Mental health is a fundamental part of that. Our approach integrates physical and mental health and makes sure our members have equitable access to care. We also work hard to ensure we comply with mental health parity requirements under existing guidance.
"At this time, we are reviewing the Biden-Harris Administration's new proposed rule. We will be prepared to work with federal and state regulators to make any changes required if the rule gets finalized."
This story was updated with a comment from Rodrigo Cerda.