Bill would crack down on ‘ghost networks’, which are improperly listed by health plans as taking new patients or in-network
Washington, D.C. — U.S. Senators Ron Wyden (D-Ore.) and Tina Smith (D-Minn.) today introduced legislation to improve mental health coverage. Specifically, the bill would crack down on inaccurate health care provider listings or “ghost networks,” and create stronger enforcement standards to protect those seeking mental health care.
“Too often, Americans who need affordable mental health care hit a dead end when they try to find a provider that’s covered by their insurance,” Wyden said. “Ghost networks mean that the lists of mental health providers in insurance company directories are almost useless. This legislation will create real accountability and consequences for insurance companies that refuse to do the necessary work of keeping provider directories up to date.”
“We need to treat mental health with the same urgency we treat physical health, and that means making sure everyone has access to the care they need,” said Sen. Smith. “By law, insurance companies must cover mental health just like they cover physical health, yet they’re still finding ways to dodge compliance and deny coverage. By setting stricter standards and holding insurance companies accountable for inaccurate listings, this legislation will help ensure people can access the mental health care coverage they are entitled to.”
“For too long, insurers have concealed their inadequate mental health and addiction provider networks by filling their network directories with inaccurate listings, including ‘ghost’ providers,” said former U.S. Rep. Patrick J. Kennedy, founder of The Kennedy Forum and lead author of the 2008 Mental Health Parity and Addiction Equity Act. “The Behavioral Health Network and Directory Improvement Act will strengthen plan networks and help remove the inaccuracies that prevent Americans from getting the mental health and addiction care they need.”
Ghost networks refer to networks of health care providers who are listed by private insurance companies as in-network options but are not accepting patients or are no longer in-network. These inaccurate listings are a widespread problem that create logistical and financial barriers for patients seeking mental health care.
Senators Wyden and Smith’s Behavioral Health Network and Directory Improvement Act would address these issues by holding health plans to a higher network adequacy standard and requiring health plans to conduct independent audits to ensure their provider networks are up-to-date and accurate. Specifically the bill would:
· Strengthen and enforce directory accuracy standards. The bill would require health plans to conduct independent audits and the federal government to conduct separate audits on the accuracy of health plans’ provider networks and to post this information publicly online. The federal government will also be authorized to issue civil monetary penalties (CMPs) against health plans for failure to comply with network adequacy and directory accuracy requirements.
· Ensure providers submit timely information. The bill would require providers to regularly update the information they submit to health plans, including timely information on whether they can accept new patients.
· Hold health plans accountable to a higher network adequacy standards. The bill would improve the standard for the adequacy of a health plan’s mental health and substance use disorder provider network, including by considering the ratios of behavioral health providers to patient, waiting times for an appointment, and geographic accessibility of providers.
· Protect the rights of consumers. The bill would establish State and Tribal ombudsman programs to educate individuals on their rights under the federal mental health parity law. In addition, the bill requires health plans to inform individuals enrolled in a plan with a ghost network that they may be eligible for a refund if they see a provider incorrectly listed as in-network in the plan.
· Improve mental health provider network participation. The bill would require federal agencies to establish a standard for parity in reimbursement for mental health and physical health services by private health plans.
The legislation is endorsed by The Kennedy Forum, SMART Recovery, National Register of Health Service Psychologists, Postpartum Support International, International OCD Foundation, 2020 Mom, Inseparable, Network of Jewish Human Service Agencies, American Psychiatric Association, Legal Action Center, American Foundation for Suicide Prevention, NAMI MN, Eating Disorders Coalition for Research, Policy & Action, REDC Consortium, American Counseling Association, National Federation of Families, and Mental Health Minnesota. You can read a full summary of the bill here.
Senator Wyden has been a leader on improving mental health care as chairman of the Senate Finance Committee. Throughout the 117th Congress, he has worked on a bipartisan basis in the committee to address key areas for improving mental health care, including the mental health workforce, telehealth, youth mental health care, mental health parity, and integrating mental health and physical health. In March, the Finance Committee heard about the prevalence of ghost networks and other shortfalls in the mental health care system from the Government Accountability Office. The committee has released four discussion drafts including dozens of policies to improve the mental health care system for youth, older Americans and families.
As a member of the Senate Health and Education Committee, Senator Smith is leader in the fight to make mental health care more affordable and accessible. As part of the American Rescue Plan, Smith passed bipartisan provisions with Senator Murkowski to provide expanded access to community based mental health care and harm reduction services. She has also introduced a host of bipartisan legislation aimed at increasing mental health services for students, improving integrated care, increasing access to tele-mental health, and investing in the mental health workforce. Last year, she introduced the Medicaid Bump Act to expand access to mental health services for low-income families and children, older adults and people living with disabilities. Smith has also spoken on the Senate floor and regularly shares her story about her personal experience with depression in an effort to destigmatize talking about mental health.
A web version of this release is here.