Ending 'Ghost Networks': Improving Access and Parity for Behavioral Health Care.
This Act aims to eliminate 'ghost networks'—inaccurate provider directories—in health insurance, which often block access to mental health and substance use disorder services. It mandates annual, independent audits of provider directory accuracy and requires health plans to meet new national quantitative standards for network adequacy, including acceptable waiting times. Citizens gain cost-sharing protections, ensuring they are not penalized with higher out-of-network costs if they relied on inaccurate directory information.
Key points
Increased Directory Accuracy: Health plans must verify and update provider information every 90 days, including whether providers are accepting new patients, languages spoken, and if they offer medication-assisted treatment for opioid use disorder.
Protection Against 'Ghost Networks': The Act defines 'ghost network' (directories with substantial inaccurate or non-existent listings) and requires health plans to undergo annual, independent audits, with results made publicly available.
Cost-Sharing Refund for Errors: If a patient sees a non-participating provider mistakenly listed as in-network, the plan must notify the patient of their eligibility for a refund of the out-of-network cost difference.
Strengthening Mental Health Parity: New national quantitative standards for mental health and substance use disorder network adequacy will be established, considering factors like geographic accessibility and appointment waiting times.
Consumer Support: Grants will establish State and Tribal ombudsman programs to educate consumers, investigate complaints, and help resolve issues related to mental health and substance use disorder coverage parity.
Expired
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