What GAO Found
Based on stakeholders interviewed and research reviewed, GAO found that consumers with coverage for mental health care experience challenges finding in-network providers. For example, providers listed as in-network may not be accepting new patients or may not actually be in a patient’s network. Such challenges could cause consumers to face higher health care costs, delays in receiving care, or difficulties in finding a provider close to home. Factors contributing to these challenges included low reimbursement rates for mental health services and inaccurate or out-of-date information on provider networks, according to stakeholders and research GAO reviewed.
GAO also found that consumers experience challenges with restrictive health plan approval processes and plan coverage limitations, which can limit their ability to access services. Many of the 29 stakeholder organizations interviewed and reports GAO reviewed noted that the process for getting approval for coverage for mental health services can be more restrictive than it is for medical services. For example, representatives from one health system reported that some health plans are less likely to grant prior authorization for mental health hospital stays compared with medical and surgical hospital stays. Some stakeholders also noted various coverage restrictions that limit consumers’ access to certain mental health treatments or that limit the types of providers eligible for payment. These include certain statutory restrictions on the types of mental health providers eligible for reimbursement under Medicare.
Federal efforts may address aspects of the challenges experienced by consumers attempting to access care.
Addressing Limited Access to In-Network Providers. The Department of Labor (DOL) and the Department of Health and Human Services (HHS) are taking steps to ensure access to in-network mental health providers. For example, they are taking steps to enforce requirements for certain health plans to update and maintain provider directories. In addition, the Health Resources and Services Administration within HHS manages several programs that provide funding intended to increase the mental health workforce.
Addressing Broader Structural Issues. The Substance Abuse and Mental Health Services Administration within HHS manages several programs aimed at addressing structural issues that contribute to a lack of capacity in the mental health system. This includes grant programs to increase access to community-based mental health care.
Addressing Issues with Health Plan Administrative Approval Processes. DOL and HHS are taking steps to enhance their oversight of the use of non-quantitative treatment limitations by health plans, such as requirements for prior authorization, as part of their broader responsibilities to oversee compliance with mental health parity laws. These laws require that coverage of mental health treatment be no more restrictive than coverage for medical or surgical treatment.
Why GAO Did This Study
This testimony summarizes the information contained in GAO’s March 2022 report, entitled 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@example.com.