[NYAPRS Enews] Biden Proposes Sweeping Mental Health Parity Changes

[Harvey Rosenthal]

Biden Acts On Mental Health Parity
By Ben Leonard and Daniel Payne  Politico  July 25, 2023



BIDEN ACTS ON MENTAL HEALTH PARITY — The Biden administration is proposing to boost a 2008 law that established so-called mental health parity by establishing more stringent requirements<https://url.avanan.click/v2/___https:/go.politicoemail.com/?qs=238d4fc9203eff0f531123553110c0172335657a6feed2a85b4112363dd57b10e5d46ee467fea63343ad47ccb23ae8d0___.YXAzOm55YXByczphOm86MTM4YjZiMmI1NWUwZTBlNGJiYTRlMjQ1MWY1NGE2OWM6NjpiNWRkOjA3YjE0Y2RmYTg2ZTcwMGQ3ZjcwYzg3OTZkNDEzM2FiY2RkOTdlNWE2OWYyYTgyOTllZDlhMGNmZDdkMDA4M2M6aDpU> for health plans.

It’s a significant expansion of health insurers’ responsibilities under the law. The proposed rule, announced Tuesday, would:

— Mandate that insurers analyze the outcomes of their coverage to ensure there's equivalent access to mental health care, including provider networks, prior authorization rates and payment for out-of-network providers, and take action to get in compliance

— Establish when health plans can’t use prior authorization or other tactics to make it more difficult to access mental health and substance use treatment

— Require additional insurers to comply with the 2008 law

Pointing to rising rates of mental health issues and suicide, White House domestic policy adviser Neera Tanden said in a press call that not enough Americans are able to access mental health care. She added that insurers make it harder to access mental health care in-network, forcing patients to pay out of pocket.

“This rule will stop the industry evasion that has led millions of people to pay for care even when they have insurance,” Tanden said.

The teeth: A senior administration official granted anonymity to speak about the plans said that fines could be in store for violators.

“[This] is saying to insurance companies that you need to be working to build networks for mental health services that are adequate,” the official said. The official added that the action means insurers couldn’t have so-called “ghost networks” that have many providers on paper but few that treat patients.

If insurers’ out-of-network reimbursement looks significantly different for mental health than it does for physical health, the payers would need to make payment changes, the official said.

What’s next: The administration will take comments from the public for 60 days.

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