In collaboration with Legal Action Center, we’ve explored key insurance barriers to affordable, timely and appropriate care for mental health and substance use. The result of this work is a four-report series including surveys of all 50 states and detailing recommendations to improve insurance regulation.
Policymakers, regulators, and advocates have a responsibility to ensure access to mental health and substance use care. The adoption of proposed recommendations, together with increased enforcement of the 2008 Mental Health Parity and Addiction Equity Act, would create significant improvements in care.
Spotlight on Legislation Limiting the Use of Prior Authorization for Substance Use Disorder Services and Medications
Prior authorization requirements impose a unique barrier for individuals seeking substance use disorder (SUD) treatment, delaying care at a critical moment.
Spotlight on Network Adequacy Standards for Substance Use Disorder and Mental Health Services: Federal and State Regulation and Enforcement of the Parity Act
Health insurance providers must cover a full continuum of services and a robust network of providers to ensure access to mental health and substance use disorder treatment. This report examines network adequacy standards.
Medical necessity criteria should reflect generally accepted standards of care for the patient’s condition. Yet, for substance use disorders (SUDs), some health plans have used medical necessity criteria to restrict care and control costs.
Traditional regulatory enforcement activities have proven inadequate to capture necessary compliance data or prevent the sale of sub-standard plans.