Mental health care: Covered consumers face access challenges

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What the GAO found

Based on stakeholders interviewed and research reviewed, GAO found that consumers with mental health care coverage experience difficulty finding in-network providers. For example, providers listed as part of the network may not be accepting new patients or may not be part of a patient’s network. Such challenges could cause consumers to face higher health care costs, delays in receiving care, or difficulty finding a provider near them. Factors contributing to these challenges included low reimbursement rates for mental health services and inaccurate or outdated information about provider networks, according to stakeholders and research reviewed by GAO.

The GAO has also found that consumers struggle with restrictive health plan approval processes and plan coverage limits, which can limit their ability to access services. Many of the 29 stakeholder organizations interviewed and reports reviewed by GAO noted that the process for obtaining approval for mental health services coverage can be more restrictive than for medical services. For example, representatives of one health system indicated that some health plans are less likely to grant prior authorization for mental health hospital stays than for medical and surgical stays. Some stakeholders also noted various coverage restrictions that limit consumer access to certain mental health treatments or limit the types of providers eligible for payment. These include some statutory restrictions on the types of mental health providers eligible for reimbursement under Medicare.

Federal efforts can address some aspects of the difficulties faced by consumers trying to access care.

Treatment of limited access to network providers. The Department of Labor (DOL) and Department of Health and Human Services (HHS) are taking steps to ensure access to in-network mental health providers. For example, they take steps to enforce certain health plan requirements to update and maintain provider directories. In addition, the Health Resources and Services Administration within HHS administers several programs that provide funding to increase the mental health workforce.

Addressing wider structural issues. The Substance Abuse and Mental Health Services Administration within HHS operates several programs aimed at addressing structural issues that contribute to the lack of capacity in the mental health system. This includes grant programs to increase access to community mental health care.

Resolving issues with health insurance plan administrative approval processes. The DOL and HHS are taking steps to strengthen their oversight of health plans’ use of non-quantitative treatment limitations, such as prior authorization requirements, as part of their broader compliance monitoring responsibilities. mental health parity laws. These laws require that coverage for mental health care be no more restrictive than coverage for medical or surgical care.

Why GAO Did This Study

This testimony summarizes information contained in the GAO’s March 2022 report, Mental Health Care: Access Challenges for Covered Consumers and Relevant Federal Efforts.

For more information, contact John E. Dicken at 202-512-7114 or [email protected]

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