Insurers and some employers contend the Biden administration’s recent proposal to bolster coverage of mental and behavioral care could actually backfire and make it more difficult for patients to access quality care.
The big picture: The health care payers are urging the administration to drop major features of its plan, including a new formula to determine whether insurers are improperly limiting patient access to mental health care. And a leading health insurer trade group called on the administration to scrap the whole thing.
Catch up quick: The administration in August proposed new rules to strengthen enforcement of a 2008 law that requires insurers to cover mental health services at the same level as physical health care.
- Under the proposal, a health plan could only use treatment limits like prior authorization on a mental health or substance use service if it also uses the limits on two-thirds or more of its medical benefits in the same class.
- The rule would also require the plans to collect and evaluate data on the impact of their treatment limits on mental health benefits.
What they’re saying: The proposed rules are “so burdensome that many of our members will have no other choice but to re-think the type and level of their plans’ coverage” of mental health benefits, wrote the ERISA Industry Committee, which advocates for employers on health benefits issues.
- In comments to federal regulators, the organization argued the rules go beyond the administration’s authority to discourage limits on mental health and substance use treatment – hinting it may sue if officials finalize the policy.
- AHIP, an insurance industry lobbying group, said officials should withdraw the entire proposal and restart the process to address what it says are significant legal and operational flaws in the plan.
- Insurers also defended the use of strategies like prior authorization to ensure that patients receive appropriate medical care.
- “If this approach is restricted, patients will pay more for treatment that varies widely in quality,” wrote the Blue Cross Blue Shield Association.
The other side: Mental health professionals and advocates voiced support for the administration’s formula for determining whether limits on mental health treatment are too restrictive.
- Similar metrics already in use for determining whether mental health treatments are too costly or too limited in duration have increased mental health parity compliance, one advocacy coalition wrote to officials.
- The coalition, called the Mental Health Liaison Group, also suggested officials nix some proposed exceptions for insurers written into the policy.