US Senators Tina Smith, Ron Wyden reintroduce legislation to strengthen mental health care coverage, hold insurance companies accountable

WASHINGTON – Last week, US Senators Tina Smith (D-MN) and Ron Wyden (D-OR) introduced legislation to improve coverage for mental health and substance use disorder care. Specifically, to Behavioral Health Network Act and Directory Improvement would crack down on health insurers’ tactics of posting incomplete and inaccurate provider lists — 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 Senator Smith. “By law, insurance companies must cover mental health just as they cover physical health, yet they are still finding ways to avoid 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 shocking how common it is for people who need treatment to find that their health insurance is next to useless when they try to see a mental health provider.”, said Senator Wyden. “In the worst cases, these phantom networks are essentially a fraudulent product, but health insurance companies continue to sell those policies for top dollar. In almost any other industry, the customer would be owed a refund. This bill is about closing loopholes in federal law and establishing real accountability for health insurance companies that continue to sell these phantom network insurance policies.

Phantom health care provider networks are providers listed by private insurance companies as in-network options, but who do not accept patients or are no longer in the network. These inaccurate listings are misleading and a common problem that creates logistical and financial barriers for patients seeking mental health care.

of Behavioral Health Network Act and Directory Improvement would address these issues by holding health plans to a higher standard of network adequacy and requiring health plans to conduct independent audits to ensure that their networks of health care providers are up-to-date and correct. Specifically, the bill will:

  • Enforce and enforce network accuracy standards. The bill would require health plans to conduct audits and the federal government to conduct separate reviews of the accuracy of health plan provider networks and post this information publicly online. The federal government would also be authorized to issue civil monetary penalties against health plans for noncompliance with network adequacy and accuracy requirements.
  • Ensure providers submit information on time. 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 eligibility standards. The bill would improve standards for eligibility of health plans for mental health and substance use disorder provider networks, including taking into account behavioral health providers’ patient-to-patient ratios, wait times for an appointment, and providers’ geographic accessibility .
  • Protect consumer rights. The bill would create state and tribal ombudsman programs to educate individuals about their rights under the federal mental health equity law. In addition, the bill requires health plans to inform individuals enrolled in a plan with a phantom network that they may be eligible for reimbursement if they see a provider incorrectly listed as in-network on the plan.
  • Improve participation in the network of mental health providers. The bill would require federal agencies to set standards for equity in reimbursement for mental health and physical health services by private health plans to reduce barriers to 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. it Behavioral Health Integration Act was signed into law by President Biden last year. She introduced Telemental Health Care Access Act to remove barriers to tele-mental health, Mental Health Services Student 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 with disabilities.

You can read a full summary of the bill here.

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