Wyden, Smith Introduce Legislation to Strengthen Mental Health Care Coverage, Hold Insurance Companies Accountable
"Too often, Americans who need affordable mental health care hit a dead end when they try to find a provider that's covered by their insurance," Wyden said. "Ghost networks mean that the lists of mental health providers in insurance company directories are almost useless. This legislation will create real accountability and consequences for insurance companies that refuse to do the necessary work of keeping provider directories up to date."
"We need to treat mental health with the same urgency we treat physical health, and that means making sure everyone has access to the care they need," said
"For too long, insurers have concealed their inadequate mental health and addiction provider networks by filling their network directories with inaccurate listings, including 'ghost' providers," said former
Ghost networks refer to networks of health care providers who are listed by private insurance companies as in-network options but are not accepting patients or are no longer in-network. These inaccurate listings are a widespread problem that create logistical and financial barriers for patients seeking mental health care.
Senators Wyden and Smith's
* Strengthen and enforce directory accuracy standards. The bill would require health plans to conduct independent audits and the federal government to conduct separate audits 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 (CMPs) against health plans for failure to comply with network adequacy and directory 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 a higher network adequacy standards. The bill would improve the standard for the adequacy of a health plan's 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 a standard for parity in reimbursement for mental health and physical health services by private health plans.
The legislation is endorsed by
As a member of the
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Original text here: https://www.wyden.senate.gov/news/press-releases/wyden-smith-introduce-legislation-to-strengthen-mental-health-care-coverage-hold-insurance-companies-accountable
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