But the proposal could draw a backlash from the insurance industry and its allies in Congress, who may see the administration’s allegations as a scapegoat masking larger problems: the spike in mental illnesses and the shortage of providers trained to treat them.
Because matter: More than 20 percent of U.S. adults have a mental health problem, and more than 1 in 5 young people ages 13 to 18 have had a « severely debilitating mental illness » in their lifetime, according to the CDC.
What’s in the rule: Regulations from HHS and the Treasury and Labor departments would require insurers to analyze their coverage to ensure equivalent access to mental health care based on outcomes.
Companies should examine how they respond to physicians’ requests to approve treatments for mental versus physical illnesses, as well as their provider networks and how much they reimburse out-of-network providers.
The rule would also stipulate when health plans cannot require doctors to obtain prior authorization from insurers to prescribe a drug or procedure, or otherwise place roadblocks for patients seeking mental health care, as well as substance use.
Insurers could face fines for failing to offer comparable mental health coverage.
Progress: Tanden argued that insurers are making it more difficult for their subscribers to access mental health care from the providers who underwrite their insurance, by forcing subscribers to pay out of pocket.
The administration says insurers sometimes fail to establish adequate networks of in-network mental health providers, leaving subscribers with « ghost networks » that force them out of the network.
The administration hopes the rule will force insurers to pay providers more to build their networks.
An overall shortage of doctors, exacerbated by the fact that many are uninsured, could dampen the impact of the regulation.
The insurer’s point of view: AHIP, the lobbying organization for health insurers, acknowledged the difficulty some patients have in getting mental health care, but said the problem it is ingrained the shortage of doctors.
The group also said its members work hard to ensure supplier listings are up to date.
What’s next? The administration has not yet released the text of the regulation. Once done, they will be open for 60 days of public comment, after which they may be finalized.