Overview: Associations that represent the insurance companies oppose a new proposal from the Biden-Harris administration that would force them to comply with requirements related to mental health parity. These groups are advancing unsupported arguments to patients, caregivers, healthcare providers, and the technology community regarding the current rulemaking process. We outline the myths and the facts below.
Myth: The MHPAEA proposed regulation will substantially limit, if not eliminate, the ability of health plans to use utilization management tools such as prior authorization and concurrent review.
Fact: There is nothing in the proposed rule issued by the Biden-Harris administration that would stop health plans from continuing to employ utilization management tools to manage the care of their members. Under the proposed rule, health plans must only ensure that the application of these tools for MH/SUD benefits match the application of these tools for M/S benefits. Given the use of utilization management tools as a common feature of managing M/S benefits, there should be no obstacle for health plans to create parity for their application to MH/SUD benefits.
Myth: The MHPAEA proposed regulation would hinder a health plan’s ability to inform a provider or a consumer that virtual treatments are covered and available under their plan.
Fact: The associations claim that if insurance companies are unable to employ utilization management tools they will be unable to share with patients innovative virtual healthcare options that are covered under their health plan. First, as noted above, there is nothing in the proposed rule that would stop a health plan from continuing to apply utilization management tools – so long as they are used on par with medical and surgical benefits.
Second, health plans have many ways they can communicate with their members about covered benefits. Under the Affordable Care Act, patients have a legal right to an easy-to-understand summary of a health plan’s benefits and coverage. Furthermore, many health plans choose to communicate routinely with their members about innovative programs or offerings they provide that go above and beyond a basic summary. For example, Cigna has shared information with healthcare consumers about their virtual behavioral healthcare offerings through social media. Nothing in the proposed regulations would change health plans’ ability to continue to share information about virtual MH/SUD health options.
Lastly, the most important thing to preserve robust access to telehealth services is for Congress to maintain telehealth flexibilities put in place during the COVID-19 pandemic. As the National Strategy for Mental Health and Substance Use Disorders recommends, “Congress should pass legislation to ensure the availability of mental health and substance use disorder (MH/SUD) services via telehealth, which is critical to expanding access to treatment.” We should all be working together to ensure Congress makes this change permanent on behalf of patients.
Myth: In evaluating whether a health plan’s MH/SUD provider network is on par with its M/S network, the proposed rule provides no credit for virtual behavioral health in assessing a network’s adequacy. If the rule is finalized in its current form, and health plans don’t get credit for including telehealth and virtual services in their networks, the growth of telehealth and virtual behavioral health companies could stagnate.
Fact: Innovative behavioral health solutions, such as virtual mental healthcare options, are tools we must use more to address the MH/SUD crisis across our country. The proposed rule would not prevent a health plan from reimbursing licensed healthcare providers who provide care using virtual tools and applications.
The proposed rule would not include technologies as part of the provider network (e.g. asynchronous coaching and messaging apps). If such technologies were allowed to be counted, that could suggest a health plan’s provider network is more robust than it is. There is already a well-documented problem with ghost provider networks – allowing technologies to masquerade as actual licensed healthcare providers would only worsen the problem.