New Biden administration rules aim to hold insurers accountable for mental health care coverage

16th September 2024   ·   0 Comments

By Maya Miller and Annie Waldman
ProPublica

The Biden administration announced on last Monday that it has finalized new regulations to strengthen protections for mental health care coverage and hold insurance companies accountable for unlawfully denying it.

The rules update the Mental Health Parity and Addiction Equity Act, which was passed in 2008, requiring health insurance plans to provide the same access to mental health care as medical care. The new provisions will force health insurance plans to collect and report more robust data on how they limit and deny mental health claims. If disparities exist between mental and medical care, insurers will need to lay out how they are attempting to address these gaps.

“Mental health care is health care. But for far too many Americans, critical care and treatments are out of reach,” President Joe Biden said in a press release announcing the final rules. “There is no reason that breaking your arm should be treated differently than having a mental health condition.”

The updated rules seek to address a problem captured in numerous studies and reports and examined in a new level of detail in a recent ProPublica investigation.

Although nearly all Americans have health insurance, millions still can’t access mental health care. ProPublica found that insurance companies have interfered with patient care, deployed aggressive audits and set reimbursement rates so low that providers felt they had no choice but to quit insurance networks. Our reporting also documented how consequences can be fatal when patients can’t find therapists or mental health treatment.

Federal regulators have struggled to police insurance companies. Nearly all of the recent reports that the Department of Labor has collected from insurers and health plans have lacked enough detail to determine companies’ compliance with the law, the department reported to Congress last year. Some states have passed laws to close those gaps in information, but we found mental health protections often depend on where one lives.

The new rules require insurers to collect and turn over outcomes data, like denial rates, to measure how often patients access care. The companies will have to disclose details on insurance networks, which may include how regularly patients go out of network for mental health treatment and how reimbursement rates are calculated for mental health providers.

The rules also clarify that patients have the right to access this data and require insurers and health plans to furnish records within 30 days of a request.

Republican U.S. Rep. Virginia Foxx, R-N.C., who chairs the Committee on Education and the Workforce, said the rules are too burdensome. “These rules do nothing to improve mental health care access and instead put paperwork over patients,” she said in an emailed statement.

But former U.S. Rep. Patrick J. Kennedy, who sponsored the 2008 parity bill and co-founded the mental health advocacy nonprofit The Kennedy Forum, said the new rules will protect access for patients. “This is an opportunity for consumers to finally have a seat at the table,” he told ProPublica.

The law applies to 175 million people who have private health insurance. Under the new rules, these protections will also cover people with health insurance through state and local governments, about 120,000 additional Americans.

The finalized regulations came after a yearlong review process, in which three departments – Treasury, Health and Human Services, and Labor – collected thousands of public comments. The departments had initially published proposed rules in August 2023. Some of the provisions will go into effect on Jan. 1, said Lisa Gomez, the assistant secretary of employee benefits security at the Department of Labor.

“People living with mental health conditions and substance use disorders continue to face greater barriers,” she said. “That’s not fair, it’s not right and it’s against the law.”

ProPublica is a nonprofit newsroom that investigates abuses of power.

This article originally published in the September 16, 2024 print edition of The Louisiana Weekly newspaper.