APA’s Deputy Chief Executive Officer Jaime “Jim” Diaz-Granados, PhD, voiced support for the introduction of the Behavioral Health Coverage Transparency Act of 2022 (S.4616/H.R. 8512), sponsored by Sen. Elizabeth Warren (D-MA) and Rep. Katie Porter (D-CA) saying, “APA believes that the bill’s focus on metrics for the key issues of network adequacy, reimbursement parity, and denial rates will provide crucial data to address these remaining issues under the law.”
More than a decade after Congress enacted legislation to prohibit health plans from using discriminatory policies and practices to limit their enrollees’ coverage of mental and behavioral health services, plans are still finding ways to set those limits. A 2019 study by Milliman found that patients are more than five times as likely to go out-of-network for behavioral health visits than for medical or surgical care. The U.S. Department of Labor and other enforcement agencies are increasingly focusing on health plan practices that tightly restrict mental health specialist provider networks or pay lower rates for mental health services compared with other specialty services.
In response to the need for mental health parity enforcement and compliance, Warren and Porter, along with Rep. Brian Fitzpatrick (R-PA), Rep. Tony Cardenas (D-CA), and colleagues introduced the Behavioral Health Coverage Transparency Act of 2022. APA Services worked with Sen. Warren and Reps. Porter and Cardenas in drafting the legislation, which would:
- require insurance plans and third-party administrators to submit annual reports disclosing metrics regarding denial rates, reimbursement rates, and network adequacy for more meaningful reviews;
- require federal agencies to review at least 100 health insurance plans per year, including 40 randomized audits, to assess compliance;
- protect patients by creating a central online portal so that patients can easily access information about their parity rights, how insurers make parity decisions, the results of audits, and how to submit complaints; and
- support consumers by awarding grants to establish, expand, or provide support for offices of health insurance consumer assistance and health insurance ombudsman programs.
Read a section-by-section summary of the legislation (PDF, 192KB).
The association urges you to reach out to your members of Congress to encourage them to cosponsor this important legislation (S. 4616 / H.R. 8512).
For more information, contact Julio C. Abreu.