New Report Reinforces LAC’s Stance that Health Insurers Must Improve Provider Networks and Reimbursement to Ensure Equitable Access to SUD and MH Care

Washington, D.C. -Behavioral Health Parity - Pervasive Disparities in Access to IN-Network Care Continue confirms with clear outcomes data that providers of medically necessary SUD and MH care are unavailable through multiple insurance provider networks, despite plan members paying for these services and having the right to access such care without any greater burden than they face when seeking other medical services.

Across all inpatient and outpatient settings, RTI found that people utilized out-of-network SUD and MH care at significantly higher rates compared to medical/surgical care. For instance: SUD care delivered in subacute inpatient facilities was out-of-network 20.7 times more often than for medical/surgical care, and mental health care delivered in the same setting was out-of-network 18.2 times more often. While the disparity for office visits was not as staggering, people still utilized out-of-network SUD providers 4.2 times more often than medical/surgical providers while mental health care delivered in office visits was out-of-network 3.4 times more often. As our nation's overdose and mental health epidemics escalate, insurers cannot sit silently on the sidelines as individuals are forced to seek care from costly out-of-network providers.

RTI's data also demonstrates that, while workforce shortages may be part of the problem, they are not fully responsible for the lack of access to in-network care. Providers are available for those who can afford out-of-network care; they simply are not participating in plan networks.

One key reason, pulled from health plans' own data and made clear in RTI's report: reimbursement for psychiatrists, psychologists, and behavior health therapists is substantially less in virtually all states compared to reimbursement for specialty physicians and non-physician clinicians. Low reimbursement rates make it impossible for practitioners to join networks and tragically shift the payment burden to patients. Health plans can easily improve network participation of SUD and MH practitioners by using the same reimbursement strategies that RTI's data demonstrate are employed for medical practitioners: pay them at the higher ends of the reimbursement scale.

Further, the federal Mental Health Parity and Addiction Equity Act requires health plans to use comparable practices for building provider networks, including through reimbursement rates, and RTI's analysis demonstrates that health plans are not meeting their legal obligation. Health plans can and must fix this inequity that has no doubt contributed to our nation's overdose and mental health crises.

As detailed in LAC's report Building Better Networks and Improving Access to Substance Use Disorder and Mental Health Providers: Lessons from Maryland, strong quantitative metrics for network adequacy and enforcement of Parity Act compliance are paramount. The report documents how Maryland has worked to strengthen network standards and recently adopted legislation will require health plans to prove compliance with the Parity Act rather than require providers and consumers to marshal evidence of a violation. All states can and should similarly work to improve the standards and rules that shape the health plans available to their residents.

"State and federal policymakers must dramatically improve enforcement of existing quantitative network adequacy metrics, establish such standards for mental health and addiction care if they do not exist, and require plans to ensure accurate provider directories in real time," explains Ellen Weber, LAC's Sr. VP for Health Initiatives. "In addition to penalizing plans for violations of these requirements, consumers must be protected from out-of-network costs resulting from inadequate provider networks. Federal and state regulators must also act with urgency to improve enforcement of the Parity Act. Proposed federal regulations would appropriately find a health plan in violation of the Parity Act if its network composition data revealed the significant disparities in out-of-network utilization and reimbursement rates that RTI identified in most states. The Departments of Labor, Health and Human Services, and Treasury must promptly issue final regulations with this and other measures to uncover discriminatory practices and hold insurers accountable."

To learn more about LAC's efforts to strengthen Parity Act enforcement and ensure equitable access to care across health plans, visit www.lac.org/work/priorities/building-health-equity/addiction-and-mental-health-parity.

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Arianne Keegan, Director of Communications
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