HHS Final Rule On Health Insurance Exchanges Includes Strong Mental Health Provisions

The U.S. Department of Health and Human Services (HHS) issued its Final Rule on Health Insurance Exchanges this week. The Final Rule received praise from the American Psychiatric Association, Department of Government Affairs, who released the following statement about the rule:

The APA is encouraged by this rule’s promise to ensure adequate mental health provider networks within qualified health plans to be sold by individual state health insurance exchanges. Among other things, the Final Rule on Health Insurance Exchanges:

  • Requires that individual health exchanges’ governing boards include members who have experience in mental health.
  • Mandates that “Navigators” (those who help people buy insurance within the states’ health exchanges) be trained specifically to assist people with mental health needs.
  • Specifically mandates that there be adequate mental health provider networks, and by highlighting mental health and substance providers in the network adequacy standard, HHS seeks to encourage Qualified Health Plan issuers to provide sufficient access to a “broad range of mental health and substance abuse services, particularly in low-income and underserved communities.”
  • Does not allow a Qualified Health Plan insurer to be prohibited from contracting with any essential community provider.
  • Gives states flexibility to consider local demographics when developing network adequacy standards.

You can access the Final Rule on Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers by clicking on this link here.

This summary of the HHS Rule was provided by the American Psychiatric Association, Department of Government Relations.

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