Understanding why the Biden administration announced new rules Look no further than last month to improve your mental health care ProPublica coverage About this issue in August.
Nearly all Americans have health insurance, but health insurance companies pay mental health providers too little, limiting such care to millions of consumers and forcing providers into insurance networks. forcing them to withdraw from the maya miller and Annie Waldman I wrote it for ProPublica. “Our report states how the consequences can be fatal “If patients cannot find a therapist or mental health treatment,” they added.
Pay more or stop caring?
Miller and Waldman worked with two other ProPublica reporters; Dua Eldeve and Max Blauinterviewed more than 500 mental health therapists, including psychologists and psychiatrists, many of whom have been forced out of the profession. As a result, consumers with health insurance were forced to pay out-of-pocket costs or forgo their health insurance, ProPublica reported in this article.Why I left the network” NPR published the same article on August 25th.It is nearly impossible to find a therapist who will accept your insurance. The reason is as follows”
Therapists told ProPublica they joined a network of health insurance companies to reach patients who need out-of-pocket mental health care. But even within those networks, therapists face insurance systems designed to keep them out, the reporters wrote. Although nearly all Americans have health insurance, therapists have found that about half of consumers with mental illnesses do not receive treatment, ProPublica said.
The new rules will make it easier for health insurance companies to hold themselves accountable for complying with Paul Wellston and Pete Domenici’s rules. Mental Health Equity and Addiction Equity Act the 2008 Act, which expanded the Mental Health Equality Act 1996; According to this report in Milbank Quarterly. Federal and state laws regarding mental health equity require insurance companies to provide the same access to mental health care that they provide to consumers in need of medical care.
Despite these laws, health insurance companies often limit mental health coverage and delay or deny treatment, ProPublica explained. The reason is as follows. “Industry sources told ProPublica that these patients are bad for business because their disease can become chronic and costly,” the reporters wrote.
Mental health topics covered
Consumer and patient perspectives are especially important for journalists covering mental health, as so many Americans struggle to find therapists within their network. A related issue is whether health insurance companies claim to have enough mental health providers to meet the demand for such care.
As ProPublica has shown, insurers’ claims that they have a robust network of providers are mostly false. The bigger problem, ProPublica explained, may be that therapists are being paid too little and the barriers between therapists and patients are too high.
Another angle to pursue is that employers will complain that the new rules will increase health insurance premiums and force them to cut mental health care. Sarah Hansard reports for Bloomberg Law In February.
Even before the Biden administration announced new rules, Consulting firm PwC predicts in July Employers will pay up to 8% more in health care costs next year than they paid this year. of ERISA Industry CommitteeA trade group for U.S. employers with large health plans said the new rules could raise their costs. Amina Niasse reported for Reuters..
Rule affects 175 million Americans
According to the federal government, the new rules will reduce private health insurance to 150 million Americans who have insurance through their employer and more than 250,000 Americans who have health insurance through the individual market. These stories are important because they have implications for employers who provide mental health care. According to the Department of Labor, jobs outside the federal or state government Tim Clementvice president of federal affairs for Mental Health America, a nonprofit organization in Washington, DC. We advocate for policy and legislation to improve MH care.
Given the high demand for mental health and substance use disorder services, health insurance companies need to increase the rates they pay therapists, he said. Tim Clementvice president of federal affairs for Mental Health America, a nonprofit organization in Washington, DC. We advocate for policy and legislation to improve MH care.
Clement explained in an interview that the new rules will help federal health regulators evaluate insurers’ rates and networks.
“Network configuration is a big focus of the new rules,” he commented. He said some areas may have enough therapists, but in-network fees may be so low that therapists may be taken out of the network.
Prevent treatment limitations
An important aspect of the new rules, Clement noted, is that insurance companies are prohibited from imposing stricter restrictions on mental health and substance use disorders than on medical and surgical treatments. The law defines such limitations as non-quantitative treatment limitations that control the scope and duration of benefits, such as prior authorization requirements, step therapy, and additional criteria for in-network therapists. According to this statement Comments from the three federal agencies implementing the new news: the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury.
When announcing new rules, Research cited by the White House In 2019, about 21% of adults over the age of 18 had a mental illness, and 14.5% of people over the age of 11 had a substance use disorder. However, only 46.2% of adults received mental health care, and only 6.5% of adults with substance use disorders received treatment.
Additionally, the White House said consumers with insurance are nearly four times more likely to be out of network and pay higher prices for mental care than if they need physical care. Research conducted by RTI International Published in April. “And the problem is only getting worse. In recent years, the gap between access to out-of-network care for mental health and substance use disorders and benefits for physical health has widened by 85 percent,” the White House added.
Two years ago, the Federal Government Accountability Office flagged similar issues in this report.Mental health care: Targeted consumer access challenges and related federal initiatives” According to the report, consumers are having a hard time finding in-network therapists who accept new patients, and low payments to providers are contributing to this problem, with some providers having to change their plans. He added that he was getting paid more outside of the network.
Some of the rules will go into effect on January 1, 2025, but most of the requirements will go into effect on January 1, 2026, Clement said.
resource
- “Final rule issued by the Department of the Treasury to strengthen access to Departments of Labor, Health and Human Services, Mental Health, and Substance Use Disorder Benefits,” September 9, 2024.
- “Key healthcare professionals respond to administrative changes in the Mental Health Equality ActERISA Industry Committee, September 9, 2024.
- “‘I don’t want to die’: In need of mental health care, he gets trapped in the insurance company’s ghost networkProPublica, September 8, 2024.
- “Behavioral Health Equity – Pervasive disparities in access to in-network care persist.RTI International, April 17, 2024.
- “Factors influencing state-level enforcement of federal mental health parity and addiction equity laws: A cross-case analysis of four states.Journal of Health Politics, Policy, and Law, February 1, 2023.
- “Narrow networks become even tighter when searching for mental health professionalsKFF Health News, September 22, 2017
- “Insurance acceptance by psychiatrists and its impact on access to mental health care.JAMA Psychiatry, February 2014
- “A Political History of Federal Mental Health and Addiction Insurance ParityMilbank Quarterly Report, September 2010.
