NEW YORK, Sept 9 (Reuters) - The Biden Administration on
Monday said it had finalized regulation to help ensure the 175
million Americans with private health insurance have access to
affordable mental health services.
The 2008 Mental Health Parity and Addiction Equity Act
already requires insurers and corporate-backed health plans to
provide access and payment structures for mental health care
services on par with other medical services.
In practice, that is often not the case, with less than half
of U.S. adults with mental illness able to access care in 2020,
while nearly 70 percent of children cannot receive treatment,
according to studies cited by the administration.
That is partly due to a lack of mental health providers
being sufficiently covered by insurance plans, leading patients
to pay high out-of-pocket costs or to give up on care.
The final rule, proposed last summer, is aimed at closing
the gaps by requiring health insurers to evaluate which mental
health providers' services are covered by their plans, how much
those providers are paid as well as on how often they require or
deny prior authorizations for coverage.
Where needed, such requirements may push health plans to add
mental health providers to networks, according to a senior
administration official. Most of the new regulation will take
effect in 2026.
Patients enrolled in private health plans paid an average
$1,500 per year in out-of-pocket costs for mental health care,
double the amount paid by those without mental health
conditions, White House Domestic Policy Advisor Neera Tanden
said in a briefing.
Often that is because they seek coverage from out-of-network
providers, she said.
"It shouldn't be harder for you to find a provider that can
treat your eating disorder than it is to find a provider who can
treat your ulcer," said Lisa Gomez, Assistant Secretary at the
U.S. Department of Labor.
The Department of Labor regulates corporate-sponsored health
plans under the 1974 Employee Retirement Income Security Act, or
ERISA.
The ERISA Industry Committee, a trade council representing
U.S. employers sponsoring large health plans, in October,
submitted comments to the Department of Labor, claiming the rule
would create an additional cost burden for employer-sponsored
health plans and increase healthcare costs for enrollees.