Padilla Urges Biden Administration to Finalize Rules to Strengthen Mental Health Insurance Coverage

WASHINGTON, D.C. — Today, U.S. Senators Alex Padilla (D-Calif.), co-founder of the bipartisan Senate Mental Health Caucus, Chris Murphy (D-Conn.), and Peter Welch (D-Vt.) led Senators in calling on the Biden Administration to finalize the proposed mental health parity rule released in 2023. The Senators emphasized that these rules will hold insurers accountable and ensure they follow the law to cover mental health and substance use disorders the same way that they cover physical health.

The Senators highlighted the severe mental health crisis in the United States, especially among children. More than two-thirds of the 1 in 5 Americans who experience a mental health condition in any year do not receive treatment. In the latest 12 months, nearly 110,000 Americans died of drug overdoses, and nearly 50,000 Americans died by suicide.

Despite this crisis, a recent review of commercial insurance claims shows that mental health services are denied at a higher rate despite there being a greater shortage of primary care providers than mental health providers. Americans seeking care from a psychiatrist were forced to go out of network to obtain care 8.9 times more often than for medical/surgical specialists, and telehealth services were 4.7 times more likely to be out of network in cases where the patient was receiving mental health services.

“Insurance companies are still preventing patients from getting access to mental health and substance use disorder care. These deliberate practices include low reimbursement rates that keep providers from joining insurance networks and discourage new providers from entering the field, failure to contract with available providers, and managed care practices that delay critical care to patients or deny it altogether,” wrote the Senators.

“These rules will close existing loopholes in the law, expand narrow networks, and prohibit restrictive practices that prevent families from accessing care,” continued the Senators. “… These commonsense parity rules will help Americans suffering from mental health conditions or substance use disorder, reduce costs for taxpayers, and save lives.” 

In addition to Senators Padilla, Murphy, and Welch, U.S. Senators Amy Klobuchar (D-Minn.), Ben Ray Luján (D-N.M.), Ed Markey (D-Mass.), and Tina Smith (D-Minn.) also signed the letter.

Senator Padilla is a strong advocate for expanding mental health care access, especially for underserved communities. Last year, Padilla announced the launch of the bipartisan Senate Mental Health Caucus to serve as a forum for Senators to collaborate on and promote bipartisan legislation and solutions, hold events to raise awareness of critical mental health issues, and destigmatize mental health. Earlier this year, Padilla announced a Federal Communications Commission (FCC) proposal to improve the 9-8-8 Suicide and Crisis Lifeline, which contains provisions from his Local 9-8-8 Response Act of 2023 to expedite the process of connecting 9-8-8 Lifeline callers with their nearest call center so they can receive appropriate care and resources. He previously introduced a trio of bills to address the unique mental health needs of military childrenLatinos, and farm workers.

Full text of the letter is available here and below:

Dear Secretary Becerra, Assistant Secretary Gomez, and Deputy Commissioner O’Donnell:

We write to thank you for proposing rules last summer that will strengthen the Mental Health Parity and Addiction Equity Act of 2008. We urge the Departments of Health and Human Services, Labor, and the Treasury to finalize these strong parity rules as soon as possible, which will go a long way in our shared effort to address the ongoing mental health and substance use disorder (MH/SUD) crisis in this country.

More than two-thirds of the 1 in 5 Americans who experience a mental health condition in any year do not receive any treatment. The consequences are devastating to our communities. In the latest 12 months, nearly 110,000 Americans died of drug overdoses, and nearly 50,000 Americans died by suicide. Children have been among the hardest hit, with the effects of the pandemic still being felt by families and communities across the country. Yet, more than 15 years after the Parity Act was enacted with bipartisan support, insurance companies are still preventing patients from getting access to mental health and substance use disorder care. These deliberate practices include low reimbursement rates that keep providers from joining insurance networks and discourage new providers from entering the field, failure to contract with available providers, and managed care practices that delay critical care to patients or deny it altogether.

A recent review of commercial insurance claims shows that insurers continue to fall short on mental health parity. For instance, Americans seeking care from a psychiatrist were forced to go out of network to obtain care 8.9 times more often than for medical/surgical specialists, and telehealth services were 4.7 times more likely to be out of network in cases where the patient was receiving mental health services. While insurers cite a lack of available providers, there is actually a greater shortage of primary care providers than mental health providers, yet mental health services are still denied at a greater rate. In the last decade, these inequitable practices have not improved overall.

One of the critical practices that prevent people from receiving necessary mental health services is low reimbursement rates. Using Medicare as a benchmark across services, physical health providers are reimbursed 21.7 percent higher on average than MH/SUD providers (124.8% vs. 102.5% of Medicare). The data also reveals that insurers pay significantly higher rates than Medicare to boost their networks for physical health providers but fail to do the same for MH/SUD providers. When reimbursement rates are low, the money simply isn’t there to equip our health care system to treat patients for mental health conditions.

Given this data, we are grateful that the Biden Administration is acting. In the parity rules you proposed last summer, you recognized that “insurers too often make it difficult for families to access mental health treatment, causing millions of consumers to seek care out-of-network at significantly higher costs and pay out of pocket, or defer care altogether.” These rules will close existing loopholes in the law, expand narrow networks, and prohibit restrictive practices that prevent families from accessing care. Particularly important are the rules that combat the nonquantitative treatment limitations that are being used to deny mental health services to patients. These commonsense parity rules will help Americans suffering from mental health conditions or substance use disorder, reduce costs for taxpayers, and save lives.

We stand by your efforts to make mental health parity a reality and urge you to finalize the proposed rules as soon as possible. With strong rules in place, we can see the victory of this legislation fully realized and we can continue the fight to ensure that all Americans have access to mental health services without stigma.

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