Improving Network Adequacy for Mental Health Care and Substance Use Disorders

The Path Forward Coalition has released a new report by Michael Yuhas: “Equitable Access to Care for Mental Health and Substance Use Disorders: Standards, Measures, and Enforcement of Network Adequacy.” It notes that, for nearly 15 years, the Mental Health Parity and Addiction Equity Act has mandated that health care insurers cover mental health and substance use disorders (MHSUD) at the same level as medical and surgical care. Despite this requirement, in-network coverage for mental health care and substance use disorders is much less readily available than it is for other medical conditions.

The report examines network adequacy, which is the extent to which an insurer’s network includes enough MHSUD providers who are accepting new, in-network (INN) patients for a population within a given geographic area. Network adequacy is often reported qualitatively or using metrics that do not accurately reflect gaps in MHSUD coverage.

The report makes the case that improving network coverage “requires improving the way we measure adequacy—by using quantitative standards and metrics specific to MHSUD that can identify the true gaps that exist.” For example, measurements of appointment wait times do not reflect the number of people who may have sought care without ever accessing it. Simple tallies of MHSUD providers listed within a network may mask the number of providers who are no longer accepting new patients. The report makes the case that “[c]ompliance with standards should be assessed and reported for specific types of MHSUD practitioners who are currently  contracted, actively submitting claims, and available to see new patients.”

The report also examines the factors leading to a dearth of in-network MHSUD care, stating, “It is well recognized that, compared to medical/surgical practitioners, a much smaller percentage of MHSUD practitioners participate in insurance networks—in large part due to low INN reimbursement rates they are offered. . . . In-network reimbursement for primary care office visits . . . is nearly 24% higher than for MHSUD visits, with the differential being as high as 50% in some states.” It adds that many MHSUD care providers cite burdensome administrative costs as a barrier to joining insurance networks.

Highlighting the Path Forward Coalition’s work to expand access to MHSUD care, the report says, “Specific areas of focus relate to increasing access to in-network MHSUD practitioners, integration of MHSUD care into primary care setting through the evidence-based Collaborative Care model, expanding and improving access to tele-behavioral health, large-scale data analyses and aggregation, and development of quantitative tools . . . to more effectively measure and monitor [network adequacy] for MHSUD care.”

It closes by recommending that states and accreditation agencies should insist upon quantitative measures of network adequacy that are specific to MHSUD care. States and accreditors should mandate compliance with these clearly defined, quantitative standards.