White House Aims to Expand Coverage of Mental Health Treatment

The Biden administration issued a proposed rule aimed at pushing more insurers to cover Americans’ mental health care.

“Folks … I don’t know what the difference between breaking your arm and having a mental breakdown is … There is no distinction. It’s health,” said President Biden during a White House press conference earlier this week.

In 2008, Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA), which was meant to ensure that health plans treat mental health care the same as they do physical health care. Under the law, insurers could not make patients pay more for an appointment with a mental health provider than a physical health provider.

The law helped reduce co-pays for mental health care, and did away with “arbitrary limits” on the number of therapy visits a person could have each year, the president said.

Also under MHPAEA, private health insurance companies could not allow prior authorization to be more restrictive for mental health benefits than for medical and surgical benefits, according to an HHS press release.

“These were important steps, but they weren’t enough,” Biden noted.

Neera Tanden, JD, domestic policy advisor to the president, underscored that very point on a call with reporters earlier this week.

“Insurers are evading the mandate of the law,” she said. “Insurers make it difficult to access mental health coverage in-network and then consumers are often forced to seek care out of network at a significantly higher cost and pay out of pocket or … they defer care altogether.”

Health plans’ mental health networks often have fewer psychiatrists and other mental health professionals compared with other medical specialties. And, as senior officials on the call noted, there have been frequent problems with “ghost networks” — situations where there are “a lot of providers on paper,” but they aren’t available, aren’t taking new patients, or aren’t in-network.

If finalized, the proposed rule will call for health plans to conduct a “comparative analysis” of their mental versus physical health benefits.

The analysis will enable them to assess how much they pay out-of-network providers, how often prior authorizations are required, and how frequently prior authorization requests are denied, with the goal of ensuring equal access between mental health and medical benefits, according to a White House fact sheet.

“These analyses will show plans where they are failing to meet their requirements under the law, and will require plans to improve access to mental health care — by including more mental health professionals in their networks or reducing red tape to get care — to be in compliance with the law,” the fact sheet noted.

The proposed rule also clarifies “what health plans can and cannot do,” the fact sheet stated. For example, they cannot allow “more restrictive prior authorization” or “narrower networks” for mental health than for physical health.

When the MHPAEA passed in 2008, nonfederal government health plans, such as those used by state and local government employees, were excluded. To that end, the proposed rule will “codify Congressional changes” to MHPAEA and mandate that 200 more health plans providing care for approximately 90,000 persons comply with the law.

The Department of Labor, working alongside HHS and the Department of Treasury, also published a technical release soliciting feedback from stakeholders regarding “proposed new data requirements for limitations related to the composition of a health plan’s or issuer’s network.”

“Today, we took a big step on coverage,” Biden said. “Now we need to keep expanding care — for example, by increasing access to telemedicine [and] expanding our mental health … workforce — [of] doctors, therapists, and counselors.”

The American Medical Association issued a press release attributable to President Jesse M. Ehrenfeld, MD, MPH, commending the Biden administration for its “commitment to addressing insurers’ continued failures to comply with” the MHPAEA.

“When behavioral health treatment is delayed or denied, the results can be tragic and for far too long, insurers have created improper barriers to care through unnecessary administrative burdens including prior authorization, inadequate networks, lack of benefits, and other denials or delays in necessary care,” said Ehrenfeld.

“We urge the Biden administration to provide the Labor Department with the necessary resources to make oversight and enforcement of MHPAEA a top priority. We hope the Labor Department, as well as states, will increase efforts to regularly review plans to ensure they are in compliance with MHPAEA — and hold insurers accountable if they are not,” he added.

However, Virginia Foxx (R-N.C.), chairwoman of the Committee on Education and the Workforce, took a different view.

“Employers have struggled for the past 2 years to read the minds of Washington bureaucrats. These rules pile on an already confusing reporting process,” she said.

Additionally, Foxx argued that, with this proposed rule, the Department of Labor aims to “dictate private reimbursement rates by telling health plans they could risk a parity violation by reimbursing providers ‘at or near Medicare reimbursement rates’ … It is not up to DOL to determine the correct reimbursement for providers. That decision should be made by the private market.”

Stakeholders will have 60 days to provide comment on the rule once it is posted in the Federal Register.