Surging mental health needs challenge health care, but also provide opportunities

ARTICLE | December 05, 2024

Authored by RSM US LLP

Twenty-three percent of adults deal with mental illness annually, based on a recent study by the Substance Abuse and Mental Health Services Administration (SAMHSA). The Department of Health and Human Services and related agencies recognize the need to ease restrictions on access to mental health and wellness services—and as a result, a recent ruling should give runway to broader access starting in 2025.

How we got here

The Mental Health Parity and Addiction Equity Act was implemented in 2008 to address access to and the quality of mental health and substance use benefits. This effort has evolved, and a new government ruling will mandate that mental health and substance use disorder services be “no more restrictive” than the requirements and limitations around medical and surgical benefits. The ruling eliminates prior authorizations for certain mental health treatments, nonquantitative treatment limitations, and out-of-network cost issues specifically for group health plans and health insurers, among other issues.

What does this mean for consumers?

The new regulation brings bold changes that broaden access to mental health care. Currently, certain restrictions for individuals covered by either a group or an individual health insurance plan create barriers to mental health care access. They include limits on treatment visits and lengthy prior authorization processes that typically delay care to those in a vulnerable state. These restrictions, along with a range of regulatory issues, contribute to the fact that over half of adults with mental health or substance use conditions are unable to receive the care needed.

The recent changes are part of a broader strategy set out by the Biden administration to combat the nation’s mental health crisis, focusing on how mental health issues are understood and how treatment is accessed, provided, and integrated within and outside of health care settings. The president’s fiscal year 2024 budget included $10.8 billion to help SAMHSA address behavioral health needs and increase access to quality care, up from $7.5 billion in 2023, according to SAMHSA.

The need for this funding is apparent. Since the National Suicide Prevention Lifeline was transitioned to the 988 Suicide & Crisis Lifeline in July 2022, usage has surged, illustrating the demand for mental health care services. Over the past two years, the number of contacts with the 988 lifeline has soared by 32%.

What can providers do to prepare?

Bold changes like the recent government ruling create opportunities for all health care providers to address the surge in demand head-on. Strategies providers should consider include:

1. Upskilling: Providers should educate their workforce on the new rules and their impact on daily operations. Partnering with trusted advisors can help identify relevant training and educational programs.
2. Compliance: Organizations must update their paperwork and coding practices to avoid financial penalties. Strong enterprise risk and internal audit teams are crucial for effective monitoring.
3. Outreach: Clear and timely communication with patients and members is essential. A multichannel approach, combining both in-person and digital outreach, can ensure effective dissemination of information. Health care providers can use a combination of email, text messages and social media, while also scheduling in-person meetings or phone calls to reach their patients and members.
4. Collaboration: Insurance carriers and other strategic partners must work together to ensure a smooth transition. Regular communication is essential to align efforts and avoid pitfalls like claim denials.
5. Technology assessment: Health care leaders must assess their existing technology to determine its compatibility with the new rules and processes. Electronic health records may need to be updated to accommodate new coding and clinical documentation standards.