June 17, 2024

The White House warns insurance companies about mental health care

The Biden administration on Tuesday announced proposed new rules to strengthen legislation requiring insurance companies to cover mental health benefits as much as medical and surgical benefits, with administration officials citing Americans’ lack of access to mental health care.

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

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

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

“In 2020, less than half of Americans with mental health needs receive the mental health care they most need,” Tanden said. “And too many Americans are struggling to cover that care. It’s not that 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. Inadequacy would be determined through analysis that seeks to see if companies are failing to meet legal requirements.

However, insurance companies have not previously been found to perform these analyzes as thoroughly as the federal government would have hoped.

Department of Labour, Department of Treasury and Health and Human Services reported to Congress

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

“Because of this high percentage, [Employee Benefits Security Administration] concluded that many plans and issuers were deficient in their statutory obligation to perform and document the required analyses,” last year’s report stated.

Violations of the MHPAEA include insurance companies not offering out-of-network providers or inpatient benefits for mental health or substance abuse treatment even though those benefits are offered for medical and surgical services.

A company also violates if it charges a higher premium for mental health services, imposes broad pre-authorization requirements or fails to disclose the criteria for why benefits were denied.

Corrective measures 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 to get care.

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

The final change proposed by the Biden administration would close the loophole under the original MHPAEA enactment that did not require state and local government employee health plans to comply with federal law.

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

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

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

Officials did not reveal any plans for penalties on health insurance companies that do not comply. Without revealing a strict timeline, an administration official said the rules would be finalized in the near future.

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