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But the proposal could draw a backlash from the insurance industry and its allies in Congress, who could see the administration’s accusations as scapegoating that masks broader problems — the spike in mental illness and a dearth of providers trained to treat it.
Why it matters: More than 20 percent of U.S. adults have a mental health problem, and more than 1 in 5 youth between ages 13 and 18 have had a “seriously debilitating mental illness” during their life, according to the CDC.
What’s in the rule: The regulations from HHS and the Treasury and Labor departments would mandate that insurers analyze their coverage to ensure equivalent access to mental health care based on outcomes.
The companies would have to look at how they respond to requests from doctors to authorize treatments for mental illness, as compared to physical ones, as well as their provider networks and how much they reimburse providers out of network.
The rule would also establish when health plans can’t require doctors to obtain the insurers’ prior authorization to prescribe a medicine or procedure, or otherwise put up roadblocks for patients seeking mental health, as well as substance use, treatment.
Insurers could face fines for failing to offer comparable coverage for mental health.
State of play: Tanden argued that insurers are making it harder for their subscribers to access mental health care from providers who take their insurance, forcing the subscribers to pay out of pocket.
The administration contends that insurers sometimes fail to establish adequate networks of in-network mental health providers, leaving subscribers with “ghost networks” that force them to go out of network.
The administration hopes the rule would force insurers to pay providers more in order to build their networks.
An overall shortage of clinicians, exacerbated because many don’t take insurance, could dampen the regulation’s impact.
Insurers’ view: AHIP, the lobbying organization for health insurers, has acknowledged the difficulty some patients have in obtaining mental health care, but has said the problem is rooted in the clinician shortage.
The group also has said its members work hard to ensure provider listings are up to date.
What’s next? The administration hasn’t yet released the text of the regulations. Once it does, they’ll be open for 60 days of public comment, after which they could be finalized.
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