WASHINGTON — Last week, U.S. Senators Tina Smith (D-MN) and Ron Wyden (D-OR) introduced legislation to improve coverage for mental health and substance use disorder care. Specifically, the Behavioral Health Network and Directory Improvement Act would crack down on health insurance tactics of posting incomplete, inaccurate lists of providers – called “ghost networks”— and create stronger enforcement standards to protect those seeking mental health care.
“Mental health needs to be treated with the same urgency as physical health, and that means making sure everyone has access to the mental health care they need without unnecessary delays and barriers,” said Sen. Smith. “By law, insurance companies should cover mental health just like they cover physical health, yet they’re still finding ways to dodge compliance and deny coverage to customers. By setting stricter standards and holding insurance companies accountable for inaccurate listings, this legislation will help ensure people have access to the mental health care coverage they deserve.”
“Amid a nationwide mental health crisis, it’s outrageous how common it is for people in need of treatment to find that their health insurance is almost useless when they try to see a mental health provider,” said Sen. Wyden. “In the worst cases these ghost networks are essentially a fraudulent product, but health insurance companies continue to sell those policies for top dollar. In just about any other industry, the customer would be owed a refund. This bill is about closing gaps in federal law and establishing real accountability for health insurance companies that continue to sell these ghost network insurance policies.”
Ghost health care provider networks are providers listed by private insurance companies as in-network options but who aren’t accepting patients or are no longer in-network. These inaccurate listings are misleading and a common problem creating logistical and financial barriers for patients seeking mental health care.
The Behavioral Health Network and Directory Improvement Act would address these issues by holding health plans to a higher network sufficiency standard and requiring health plans to conduct independent audits to ensure their health care provider networks are up-to-date and accurate. Specifically, the bill would:
- Strengthen and enforce network accuracy standards. The bill would require health plans to conduct audits and the federal government to conduct separate reviews on the accuracy of health plans’ provider networks and to post this information publicly online. The federal government will also be authorized to issue civil monetary penalties against health plans for failure to comply with network adequacy and accuracy requirements.
- Ensure providers submit timely information. The bill would require providers to regularly update the information they submit to health plans, including timely information on whether they can accept new patients.
- Hold health plans accountable to higher network adequacy standards. The bill would improve standards for adequacy of health plans for mental health and substance use disorder provider network, including by considering the ratios of behavioral health providers to patient, waiting times for an appointment, and geographic accessibility of providers.
- Protect the rights of consumers. The bill would establish State and Tribal ombudsman programs to educate individuals on their rights under the federal mental health parity law. In addition, the bill requires health plans to inform individuals enrolled in a plan with a ghost network that they may be eligible for a refund if they see a provider incorrectly listed as in-network in the plan.
- Improve mental health provider network participation. The bill would require federal agencies to establish standards for parity in reimbursement for mental health and physical health services by private health plans to reduce barriers to in-network participation by providers.
Senator Smith, a member of the Health, Education, Labor and Pensions Committee, has long been involved in making mental health care more affordable and accessible. Her Improving Access to Behavioral Health Integration Act was signed into law by President Biden last year. She introduced the Telemental Health Care Access Act to remove barriers to tele-mental health, the Mental Health Services for Students Act to strengthen school-based mental health services for students in kindergarten through 12th grade, and the Medicaid Bump Act to expand access to mental health services for low-income families and children, the elderly and people living with disabilities.
You can read a full summary of the bill here.
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