Biden Administration Finalizes Rule to Expand Access to Affordable Mental Health Care for Millions

64

The Biden Administration has officially enacted a new regulation aimed at ensuring that the 175 million Americans with private health insurance can access affordable mental health services. The move builds upon the 2008 Mental Health Parity and Addiction Equity Act, which already mandates that insurers and employer-backed health plans provide equal access to mental health services alongside other medical services.

However, despite the law’s existence, many Americans still face significant barriers to mental health care. According to studies referenced by the administration, less than half of U.S. adults with mental illnesses were able to access treatment in 2020, and nearly 70% of children did not receive the care they needed. This gap is largely attributed to a lack of mental health providers covered by insurance plans, resulting in high out-of-pocket costs for patients or their decision to forego care altogether.

One of the main goals of the new regulation is to tackle the issue of inadequate mental health provider networks within insurance plans. Dr. Jared Skillings, chief of professional practice at the American Psychological Association, emphasized that low pay for mental health professionals is a major cause of network inadequacy. He also challenged the notion that workforce shortages are the primary reason for limited mental health provider networks, a view held by some insurance companies.

The finalized rule, initially proposed last year, seeks to address these gaps by requiring health insurers to thoroughly evaluate their mental health coverage. This includes assessing which mental health providers are part of their network, how much these providers are compensated, and the frequency with which prior authorizations for mental health services are required or denied.

According to a senior administration official, the regulation is designed to encourage health plans to expand their mental health provider networks where necessary. This would help reduce the reliance on out-of-network providers, a common issue that often forces patients to pay significant out-of-pocket costs.

The majority of the changes outlined in the regulation are set to take effect in 2026, giving insurers time to adjust their practices and expand their mental health provider networks. The regulation aims to make it easier for Americans to access affordable mental health care without having to navigate complex insurance policies or face exorbitant costs for out-of-network care.

White House domestic policy adviser Neera Tanden pointed out that patients enrolled in private health plans currently pay an average of $1,500 annually in out-of-pocket costs for mental health services, largely because they have to seek treatment from out-of-network providers. The new rule aims to alleviate this financial burden by encouraging insurers to better cover in-network mental health services.

Lisa Gomez, Assistant Secretary at the U.S. Department of Labor, highlighted the importance of improving access to mental health care, emphasizing that it should not be more difficult to find a provider to treat a mental health condition like an eating disorder than it is to find a provider for a physical ailment like an ulcer.

The Department of Labor plays a key role in regulating corporate-sponsored health plans under the Employee Retirement Income Security Act (ERISA), a law enacted in 1974. These corporate-backed plans are subject to the same mental health parity requirements as individual health insurance policies, and the new rule is expected to apply pressure on them to comply more fully with existing laws.

Despite the benefits the regulation is intended to bring to patients, concerns have been raised by some groups representing large employers who sponsor health plans. The ERISA Industry Committee, a trade group representing U.S. employers, voiced worries about the potential financial burden the new rule could impose on employer-sponsored health plans. They argue that the regulation could lead to higher healthcare costs for both employers and employees.

In a statement, Melissa Bartlett, senior vice president of health policy for the committee, expressed concerns about the potential impact of the rule. She noted that the committee is considering all options, including litigation, to mitigate any negative effects on employers and the employees who rely on their health plans.

The Biden Administration’s new regulation marks a significant step toward ensuring that mental health care is accessible and affordable for millions of Americans. By addressing the systemic issues that have long hindered access to mental health services, the administration hopes to reduce the disparity between mental and physical health care, allowing more individuals to get the treatment they need without facing financial barriers or bureaucratic roadblocks. As the changes take effect over the next few years, insurers will be expected to expand their mental health provider networks and offer fairer compensation to mental health professionals, ultimately improving care for patients across the country.