The United States is facing a raging mental health crisis – one deemed a shadow pandemic in the midst of COVID-19. Since the onset of the coronavirus pandemic, a staggering 41% of adults have reported symptoms of anxiety or depressive disorder, up from 10% just one year earlier.1 The situation only gets worse when you look more closely.

Young adults have been hit particularly hard, with 69% of women and 54% of men aged 18 to 29 reporting negative impacts on their mental health. Marriages have suffered, with divorce rates skyrocketing in the early months of the pandemic.2 This challenging state of affairs has been fueled by fear of illness, economic downturn, isolation, and the harsh reality that one in four Americans had a close friend or family member die of complications related to COVID-19.

To help people manage their growing grief, depression, and anxiety – whether newly onset, re-opened, or chronic – we must improve access to mental health care services. The shortage of psychiatrists in the US is not new, and as we know, specialty services are not always guaranteed in the United States. In fact, a recent analysis shows that one in three adults who believed they might need mental health services in the past year did not receive them, with nearly 25% of these people in need of care saying that they could not find a provider or could not afford the cost.4

Strategies to increase the number of licensed clinical psychologists and psychiatrists in the US are still needed but there is some truly hopeful news amidst these challenges. Unlike so many instances in the past where mental health concerns have been disregarded, policymakers around the nation appear to be meeting the moment for those in need this time around. Unable to ignore the nationwide cries for help, and hot on the heels of the progress made by the American Rescue Plan, new federal requirements and unprecedented state legislation continues to be issued, with many components aimed at increasing affordable – and in some cases free – access to behavioral and mental health care.

MHPAEA Forces Health Plans to Comply with Parity Standards: SUD Treatment Access Will Widen

To ensure that health plans are providing adequate insurance coverage for mental and behavioral health care, including for substance use disorders (SUDs), the Departments of Labor, Treasury, and Health and Human Services have issued guidance for health plans and health insurers related to compliance under the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The MHPAEA requires that financial requirements and treatment limitations applied to mental health and SUD benefits are no more restrictive than for medical or surgical benefits, and while the provisions within MHPAEA have been mandatory for years, the updated guidance creates long-awaited rules aimed at enforcing those standards.5,6

Under the new requirements, group health plans must be prepared to prove that each plan complies with MHPAEA through a comparative analysis showing that all non-quantitative treatment limitations, such as prior authorization and out-of-network reimbursement rates, are comparable to, and applied no more stringently, than standards used for medical and surgical benefits. Employers must be prepared for their plans to be audited at any time.7 Plans subject to MHPAEA rules are encouraged to use the Department of Labor’s Self-Compliance Tool so that they are both designing legally compliant health plans and prepared to respond to audit requests.

As health plans begin to implement this guidance, and as audits begin to take place, we should expect to see an increase in health plans that comply with parity and equity standards, which will widen access to affordable behavioral health care across the nation.

New Mexico’s “No Behavior Cost Sharing Act” Bans Behavioral Health Copays and Deductibles

At the state level, New Mexico’s “No Behavioral Cost Sharing” Act was signed into law in early April.8 The new legislation expressly prohibits health insurance plans from imposing cost-sharing on any and all behavioral health services. These services include the prevention and identification of mental health disorders and SUDs, inpatient and outpatient treatment and medications, detoxification, and more. The prohibition on cost-sharing applies to copayments, coinsurance, and deductibles – essentially, the plan beneficiary must not be responsible for any financial obligation for behavioral health care beyond their plan premium.

Passage of this law is a landmark moment for mental health policy in the US, as no other state has adopted such an expansive constraint on cost-sharing for behavioral health services.9 Therefore, implementation of this law has the potential to provide invaluable insight, both for New Mexico as they move forward, and for other states considering similar policy changes. With this in mind, the act requires the Superintendent of Insurance to submit annual reports to the governor and legislature regarding the elimination of cost-sharing and its effects on providers and patients, including health and social outcomes.

The new law will go into effect in New Mexico on January 1, 2022. If the law is not extended by further legislative action, it will expire on December 31, 2026.

New Jersey Teens Will Receive Free Mental Health Screenings

In late April 2021, New Jersey passed legislation to ensure that all adolescents between the ages of 12 and 18 are able to receive mental health screenings free of cost, disallowing insurers from requiring any cost-sharing related to these visits, including copayments, deductibles, or coinsurance.10 While the Affordable Care Act (ACA) already requires coverage for adolescent depression screenings, this new law ensures that this coverage will continue if the ACA is ever amended or repealed, cementing New Jersey’s commitment to youth mental health.11

The New Jersey policy is similar to the New Mexico policy but they have very different limitations. In terms of who benefits from each policy, New Mexico seems to be taking a more inclusive stance to include all ages while the New Jersey law applies only to adolescents. On the other hand, in terms of duration, New Jersey is taking a stronger stance, as its policy is specifically intended to be long-lasting. It is likely that both states, and others, will learn from one another as time goes on.

Colorado Launches Behavioral Health Administration

To improve the delivery of mental health and substance use services, Colorado has passed legislation to establish the Behavioral Health Administration.12 The newly-created agency – to be active by July 2022 – will streamline access to services by integrating state mental and behavioral health programs and funding under one entity and working to reduce bureaucracy for health care providers.13

In preparation for the agency’s launch, the Colorado State Department must submit a plan to the legislature by November 2021 detailing strategies for streamlining and improving efforts, and how the agency will integrate and/or align with Medicaid and private insurance. In creating this plan, the State Department must solicit feedback from a diverse group of stakeholders, including: consumers and consumer advocates; county, municipal, and tribal governments; managed services organizations; health care providers; insurance carriers; community mental health centers; and SUD treatment providers. If you are an affected stakeholder in Colorado, be on the lookout for opportunities to have your voice heard as this new agency takes shape.

Mental Health Care Improvements on the Horizon

With the nation focused on the state of our collective mental health, there is no shortage of exciting and innovative proposals being considered in local legislatures.

The Frontline COVID-19 Provider Mental Health Resiliency Act

To address the staggering levels of health care workers experiencing burnout as a result of the COVID pandemic, the California Assembly is currently considering the Frontline COVID-19 Provider Mental Health Resiliency Act.14 If passed, the act would require the Department of Consumer Affairs to contract with third-party vendors to provide free services to qualifying health care providers, including in-person and telehealth services to support mental and behavioral health needs resulting from the pandemic.15

The Interstate Compact for Licensed Counselors

The Interstate Compact for Licensed Counselors, which proposes to allow professional counselors who are licensed and reside in one member state to practice in all participating states, is inching closer to being enacted with the passage of related legislation in Georgia and Maryland.16  Despite passage in these two states, the Counseling Compact will only become effective in participating states when 10 states pass enacting legislation.

Mental Health Parity and Addiction Equity Act of 2008

Finally, on a less innovative but very long-awaited note, it is looking promising that Missouri may finally bring itself into compliance with the Mental Health Parity and Addiction Equity Act of 2008 (discussed above), making it the last state in the nation to do so.17 Introduced by Rep. Patty Lewis, HB 889 has been making some progress toward passage, recently making it through the House Health and Mental Health Policy Committee with a unanimous “do pass” vote.18 In its first hearing, eight witnesses testified on behalf of the bill and no one spoke against it.

While the pandemic and its associated fallout has been, without doubt, the most traumatizing event in our recent collective psyche, it has been heartening to see policymakers finally turn their attention to mental health care in a meaningful way. From reducing stigma to improving funding for programs and services to eliminating overburdensome cost-sharing, policymakers at the state and federal level are working to improve the United States’ mental health care system at a record-breaking pace. While access to care may be widening, there is still a need to address the dearth of behavioral and mental health clinicians who can provide these services. However, for the first time in a long time in regard to health care policy, this author is truly excited to see what comes next.

 

*Disclaimer: Psycom Pro and its publisher do not support any particular political or party view on the content described herein or other policy matters.

 

What’s Next: Should there be an annual mental health assessment?

Read more on overlapping psychiatric disorders and physical conditions, including assessment challenges with mental health and physical health, and a special report on depression screening gaps in the United States – and where the field of psychiatry goes from here.

 

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Last Updated: May 12, 2021