Karen Kopf’s Post

The Biden administration’s new rule gives mental health the attention is deserves, aiming to close the gap between mental and physical healthcare by holding insurers accountable. If you’ve recently tried to find a therapist in-network, you know it’s a struggle—people are almost four times more likely to go out-of-network for mental health, pushing many to forgo treatment altogether. With over 84 million adults battling mental health challenges, this rule could make a real difference, but only if insurers play ball. Will they? Read this article to learn about the new rule.  https://lnkd.in/gZpETf5i #healthcarestaffing #healthcareindustry #healthcareats #mentalhealth

This is a step in the right direction. We have seen many policies which carry exorbitant MH deductibles/copays, while physical health is covered. As Alex Stavros mentioned, we still have a lot of work to do. We need to have more incentives for high quality care, outcomes measurements, and better payment practices. The current payment system in behavioral health still incentivizes low cost, ineffective treatment providers because of reimbursement policies. One step at a time.

Big news today... after more than a decade of advocacy from groups like NAMI, the Biden-Harris administration finalized rules to strengthen the bipartisan Mental Health Parity and Addiction Equity Act (MHPAEA), which was passed in 2008. These rules aim to increase access to mental health care and lower costs for families by ensuring that insurance companies provide adequate mental health coverage. President Biden said, “Mental health care is health care. But for far too many Americans, critical care and treatments are out of reach. Today, my Administration is taking action to address our nation’s mental health crisis by ensuring mental health coverage will be covered at the same level as other health care for Americans. There is no reason that breaking your arm should be treated differently than having a mental health condition. The steps my Administration is taking today will dramatically expand access to mental health care in America.” Vice President Kamala Harris called the rules "historic" and said "President Biden and I are committed to ensuring that every person in our country has the mental health care they need to thrive. That is why we made the largest investment in youth mental health in history and are transforming how mental health is understood, perceived, and treated for all Americans. Today, we are building on this lifesaving and lifechanging work by announcing the finalization of a historic rule that will expand mental health care across our nation so more of our loved ones, neighbors, coworkers, and classmates receive the care they deserve." Read the full press release from the White House below. #doingbetter #mentalhealthmatters #youthmentalhealth #leiya https://lnkd.in/eUmXt6kh

Have you ever tried to find any type of healthcare provider or specialist through your health plan's directory only to discover the provider was (1) unreachable, (2) not in-network, or (3) not accepting new patients? If so, you are not alone, as the Office of NYS Attorney General (OAG) recently released a report which showed that 86% of the listed, in-network mental health providers were “ghost” providers. More than one in five Americans live with a mental illness and the OAG’s report paints a grim picture for those seeking or in need of access to mental healthcare treatment. Learn more in my latest piece with Isabelle Bibet-Kalinyak and Jonathan Walzman on how illegal "ghost" networks have exacerbated the mental health crisis.

Here is some good news from the Biden-Harris administration. According to the National Institute of Mental Health (NIMH), 22.8% of US adults, or 57.8 million people, had a mental illness in 2021. The number is even higher After excluding children without current health insurance and those younger than 6 years, it is estimated that 16.5 percent of U.S. children between the ages of 6 and 17 — about 7.7 million — have at least one treatable mental health disorder (i.e., depression, anxiety or ADHD. Simply put, a significant percentage of the people of the United States have mental health issues. As this article describes, Biden-Harris is doing something meaningful to help foster wellbeing with those issues. It also tells you that the MAGAt Republicans will do everything they can, added by the corrupt MAGAts on the Supreme Court to block this good work.

This week, The White House announced new efforts to ensure that mental health is covered on par with physical health. As President Biden explained: “Mental health care is health care… There is no reason that breaking your arm should be treated differently than having a mental health condition.” Mental health parity isn’t a new concept, but well-known loopholes and barriers have delayed access and prevented people from receiving care when they need it most. Such delays can limit the effectiveness of care, prolong mental health issues, and increase the cost of care down the road. In an interview with NPR, Neera Tanden, domestic policy adviser for the White House, explained, “We are providing new tools, new teeth to ensure that people have that coverage. We've seen loopholes like use of prior authorization, a lot of paperwork hurdles or different reimbursement rates or - and this has been an especially problematic challenge - really, networks that just don't have enough providers in them.” I’m excited that this new legislation is rolling out, and we need to ensure that it has an impact. I’ll be following closely and hope you will as well!

This ‘final rule’ released this week adds more needed teeth to the Mental Health Parity and Addiction Equity Act (MHPAEA), and is a big deal because it forces health insurers to cover mental health care on equal footing with physical health care, something that should’ve happened after the 2008 law. In practice, people have faced tons of hurdles, like fighting appeals - for the right level of care for the right amount of time, needing extra approvals, and paying out-of-network costs for mental health services. I have seen it firsthand with thousands of families over the past decade. It is hardly ever smooth. This rule cracks down on those unfair barriers, making sure insurers can't make it harder or more expensive to access therapy compared to physical care. The rule also pushes insurers to fix gaps in their networks (very few networks offer the full continuum of care needed to intervene effectively at the right level of care, at the right time) and payment practices. 👏 But there is still more to do; like improving the speed and ease of getting contracted, improving the detail, speed of updating, and accuracy of online network directories, and increasing rates to encourage more high quality providers and care. #MentalHealthMatters #MentalHealthParity Fact Sheet: https://lnkd.in/gihJBqEw

We still don't have parity for mental health care. A landmark report just released by the nonprofit research institute RTI International, Behavioral Health Parity – Pervasive Disparities in Access to In-Network Care Continue, documents the barriers that people with mental illness encounter when trying to access mental health care. The report shows how poorly they fare compared to people seeking other medical services and provides state-by-state findings. Key findings: People are forced to seek care from higher cost, out-of-network providers for mental health and substance use treatment — at far higher rates than for other medical and surgical care.  Mental health providers are routinely paid less than other M/S providers.   Out-of-network use was 3.5 times higher for mental health/substance use disorder treatment than for other medical services, similar to the finding from the most recent Milliman report. Learn more: https://lnkd.in/gf9AuAE2

Mental Health Parity and Addiction Equity Act (MHPAEA) Final Rule Announced by Fed. FACT SHEET: Biden-⁠Harris Administration Lowers Mental Health Care Costs by Improving Access to Mental Health and Substance Use Care Specifically, the final rule will: - Require health plans to make changes when they are providing inadequate access to mental health and substance use care. - Make it clear what health plans can and cannot do. They cannot use more restrictive prior authorization, or other medical management techniques, or narrower networks to make it harder for people to access mental health and substance use disorder benefits than their medical benefits. They must use similar factors in setting out-of-network payment rates for mental health and substance use disorder providers as they do for medical providers. - Close existing loopholes including requiring non-federal governmental health plans, like those offered to state and local government employees, to comply with its requirements. Read full Fact Sheet: https://loom.ly/d0-lKak #MHPAEA #regulations #substanceuse #mentalhealth #treatment #behavioralhealth #opioids #healthcare #healthIT

Great news to hear the Biden administration is finalizing new federal policy this week on #mentalhealth payment parity, which mandates insurance providers cover mental health at the same rate with physical health. The AAMC Research and Action Institute has previously analyzed the myriad of barriers to mental health care in the U.S., including the maze of navigating insurance networks and actually finding in-network providers. Data show that in 2020, one-fifth of all behavioral health services claims were denied by insurance companies; for individuals without insurance, accessing and affording mental health care is even more difficult. While the Mental Health Parity and Addiction Equity Act of 2008 mandates equal coverage and benefits for mental health and general medical conditions, some health insurers skirt these rules, leaving patients with a lack of available providers, inadequate insurance coverage, high out-of-pocket costs, and fragmented care. Payment parity is one critical step in the right direction towards improving care for the more than 57 million people living with mental illness. Read our full brief: