Just a few weeks ago, new legislation was finalized that stands to impact subscriber benefits in the behavioral health arena. This set of regulations is closely aligned with federal legislation, namely, the Mental Health Parity and Addiction Equity Act (MHPAEA), as well as state-specific laws, such as the Mental Health Parity Act in California, which was expanded in 2021.
Many patients report encountering a range of barriers in accessing mental health care since the MHPAEA was enacted in 2008. Due to lengthy wait lists and complex provider credentialing processes, many individuals sought care from out-of-network providers. This, in turn, burdened payers with added paperwork and customer service issues to navigate.
In recognition of the need for continued improvements in patient care, the federal Mental Health Parity Act has evolved over the past decade and a half. However, updates proved challenging to implement due to minimal resources and various jurisdictional concerns.
Experts feel this most recent update will provide clearer guidance to insurance companies in the realm of:
- How to streamline the provider network evaluation process
- Monitoring metrics related to prior authorizations for all subscribers
- Simplifying cost schedules for out-of-network provider payments
MHPAEA also outlines several ways health plans cannot operate regarding mental health and substance use coverage. For example, payers are not permitted to have a smaller provider network or utilize restrictive prior authorization/utilization management processes for these services as compared to their provider networks for physical medical care.
In addition, the MHPAEA mandate now extends to subscribers of non-federal government health plans, including but not limited to those for local or state employees. These new requirements are expected to go into effect in January 2025.
In anticipation of these changes, health plans should take some steps to prepare:
- Expand provider networks for added security before provider network evaluations take place.
- Place an additional focus on efficiency in the health care credentialing process to establish more fruitful partnerships with mental health and substance use treatment clinicians.
- Grow existing relationships with all behavioral health providers in your provider network to ensure their retention as well as member satisfaction.