Mental health push; Biden administration to require coverage parity
MILWAUKEE - New federal regulations aim to make mental health and addiction services more affordable.
But, critics say it'll spark higher premiums.
Top Biden administration leaders came to Milwaukee on Monday, Sept. 9, as they released the finalized rule. The rules were announced at an event featuring administration officials and members of the National Alliance on Mental Illness (NAMI) Wisconsin.
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"Mental health was considered a specialty care, so I ended up paying anywhere from $125 to $213 for a single session, about $430-500 for a single psych session, which is 20 minutes, just for a refill, not a new service or anything," Okoronta said. "I saw accessing healthcare as a right to life for me. So I choose to elect a second job."
On Monday, the Biden administration finalized a new rule requiring insurance companies to review their plans and make sure they are treating mental health care on par with how they treat physical health care.
That was already part of law with the Mental Health Parity and Addiction Equity Act, but the Biden administration said there have still been barriers.
"Insurance companies were profit-motivated," Acting Secretary of Labor Julie Su said. "They were putting their profits before people."
Insurance companies will have to review if they require more prior authorization for mental health.
"There are certain insurance companies that require us to do a prior authorization for a 60-minute session, which is a typical, standard session length, so that requires that our therapist takes time out of their day to call the insurance company, to answer their ten questions, or whatever," Director of Clinical Services at Wellpoint Care Network, Carey Jacobsen, said.
The insurance companies will also have to make sure reimbursements are on par with what they pay medical providers.
"There are agencies that won’t take certain insurances because the reimbursement rate is so low," Jacobsen said. "We can’t cover the cost of our therapists, we can’t cover the supervision that’s required, the licensing and regulation management."
Another issue is whether the insurance company has enough providers in network so people don’t have to wait months to get help and don’t have to turn to what can be more expensive out of network help.
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"Every day we hear from somebody who either can’t find the care they need, that their insurance doesn’t cover it," NAMI executive director Mary Kay Battaglia said.
According to a study by Mental Health America, 53% of Wisconsin teenagers who had depression in 2023 did not get mental health services.
Congresswoman Virginia Foxx, Chairwoman of the Committee on Education and the Workforce, blasted the final rule, writing:
"For over a year, we’ve been telling the Biden-Harris administration that these rules will not work. They are too vague and burdensome; they overregulate instead of allowing health plans to build robust networks; and they will increase premiums for employees already facing high health care costs. These rules do nothing to improve mental health care access and instead put paperwork over patients. Reporting regulations cannot be more important than workers’ mental health."
The new rules do not go into effect immediately, and it’s possible the insurance industry could sue to stop it.
"It’ll drive down acute care needs, other care needs," White House Domestic Policy Advisor Neera Tanden said when asked about insurance companies increasing their prices. "We really think that mental health care is an important preventive benefit as well, so we don’t expect to see those kinds of costs."