Feds Propose to Strengthen Mental Health, Substance Use Treatment Access

By Jonathan Springston, Editor, Relias Media

Several federal agencies have announced a renewed effort to ensure patients can access treatment for mental health and substance use disorders just as they can for other medical and surgical procedures.

Congress enacted the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008 to prevent group health plans and health insurance issuers that provide mental health or substance use disorder coverage from imposing less favorable limitations on those benefits than on medical/surgical benefits. However, not everyone is in full compliance.

Thus, the White House has proposed a rule that would close loopholes, provide guidance to insurers about what is and is not allowed, and require insurers to make changes when they are providing inadequate access to mental healthcare.

“Anyone who has ever lived with a mental health condition or substance use disorder — or who has a friend or family member who has — knows how hard getting through the day can be at times and should not have to be worried about facing obstacles to getting treatment,” said Assistant Secretary for Employee Benefits Security Lisa M. Gomez. “Yet, throughout the U.S., people in need of help continue to encounter illegal restrictions on their mental health and substance use disorder benefits and struggle to find mental health and substance use treatment providers that participate in their plan’s networks.”

Of the 21% of U.S. adults who were living with any mental illness in 2020, less than half received mental healthcare. Additionally, insured patients are more than twice as likely to be forced to go out of network and pay higher fees for mental healthcare than for physical healthcare.

In January 2022, the Biden administration delivered to Congress a MHPAEA report, which indicated that not only have there been ongoing coverage gaps, but it also suggested that there were no serious enforcement tools available until the law was amended in 2021. The 2023 report on MHPAEA, issued earlier this month, includes an overview of what has happened and changed in the 18 months since the 2022 report was issued.

American Medical Association (AMA) President Jesse M. Ehrenfeld, MD, MPH, said the AMA “strongly supports” tougher MHPAEA enforcement, asking the Biden administration to make this “a top priority.”

“For more than 15 years, the combined lack of enforcement and compliance with MHPAEA has been a significant factor driving the nation’s mental health crisis and substance use disorder epidemic, which have both been exacerbated by the pandemic,” Ehrenfeld said. “Insurers' egregious violations of MHPAEA contribute to growing inequities in mental health and substance use disorder care, which often falls disproportionally to historically minoritized communities.”

The American Psychiatric Association said the proposed rule is important to make sure mental health and substance use disorder services are available. “For far too long and despite efforts from the federal and state governments, many insurers have treated mental health as an afterthought to physical health, leaving patients and families dealing with mental health and addiction issues scrambling to find affordable care, or going without,” the group said.

America’s Health Insurance Plans (AHIP), a national advocacy group, said “mental health is good health, period.  We agree that everyone deserves access to mental healthcare, and that access should be on par with physical health.” AHIP indicated the rise in mental healthcare treatment since its enactment “provides strong evidence that MHPAEA is working.”

“Access to mental health has been, and continues to be, challenging primarily because of a shortage and lack of clinicians, which is why for years, health insurance providers have implemented programs and strategies to expand networks and increase access," the group explained. "We encourage the administration to work with health insurance providers, clinicians, patients and other stakeholders alike to continue to improve access."

For information about mental health resources for medical professionals, be sure to read the latest Relias Media book, Soul Shock: The Mental Health Crisis in Healthcare Professionals.