‘The rule has sticks as well’: Biden’s getting tough with health insurers

“the White House points to a 2022 report to Congress from the Health and Human Services, Labor and Treasury departments, which found that not one of the 156 insurance plans and issuers studied were following rules requiring them to measure their compliance with the 2008 law.

The problem is actually quite simple, advocates of the Biden rules say.

“The insurers are cracking down on mental health reimbursement in order to save money,” said Sen. Chris Murphy (D-Conn.).”

“Estimates vary, but the latest data from HHS indicates that more than half of adults with mental illness don’t get treatment. Treatment levels may be even lower for substance use conditions like opioid use disorder”

“The new proposed regulations, from HHS and the Treasury and Labor departments, are open for public comment until Oct. 2.

If finalized, they 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, compared with physical ones, as well as audit their provider networks and examine how much they reimburse providers out of network.

 “This is something that you would have expected the issuers and plans to be doing as part of their own internal analysis to ensure compliance,” said JoAnn Volk, co-director of the Center on Health Insurance Reforms at Georgetown University.”  

“Insurers say they agree that access to mental health care should be equivalent to that of physical health care.

But AHIP, the lobbying group for insurers, says the situation is more complicated than Biden makes out, and that workforce shortages are what’s behind barriers to care.

“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,” AHIP spokesperson Kristine Grow said in a statement.

The group said those include boosting telehealth coverage and integrating physical and mental health care. And it points to rising mental health care usage since the 2008 law as evidence that the law is working.”

https://www.politico.com/news/2023/09/17/white-house-insurer-mental-health-law-00115804

Leave a Reply

Your email address will not be published. Required fields are marked *