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Behavioral health access restricted under Affordable Care Act

Access to outpatient behavioral health care in at least one metropolitan area was limited after implementation of the Affordable Care Act’s, according to research recently published in Annals of Family Medicine.

“More than one-half of Americans struggle with a mental health condition in their lifetime and in 2014 alone, 18.1% of all U.S. adults experienced a form of mental illness,” MariaElena O. Williams, MD, department of family medicine, University of Colorado School of Medicine, and colleagues wrote. “Under the Patient Protection and Affordable Care Act (ACA), health insurance plans must include mental health services as an essential health benefit. But are these services accessible to those who need them?”

According to the researchers, plans under the ACA must include a network with an adequate number of different types of providers, including providers specializing in mental health and substance abuse services, to ensure that all services will be accessible without unreasonable delay. However, the researchers also indicated that these federal requirements do not dictate what constitutes a sufficient number of providers or unreasonable delay, leaving these components up to each state to define and enforce.

Williams’ colleagues posed as potential patients with mild-to-moderate depression and used a secret shopper methodology to contact all the behavioral health providers in the Denver Colorado metropolitan area networked through several large insurance companies about the next available appointment date. Researchers made 1,932 calls from 2014 to 2015.

Williams and colleagues found that among the providers who were networked through three insurance companies, 13% of directory entries were inaccurate. In addition, 43.6% of all calls, and 9.8% to 13.6% of calls to psychiatrists led to appointments. Researchers wrote that the data suggest a patient in the Denver area would need to call seven to 10 psychiatrists, depending on the insurance company, to find an available appointment.

“These findings are consistent with similar studies conducted in other regions, suggesting that access to outpatient behavioral health care is limited despite existing ACA regulations,” Williams and colleagues wrote.

“Since we conducted our study, federal guidelines were added that require monthly directory updates, which we hope will reduce the number of directory inaccuracies. Despite this, we believe that the nonspecific requirements outlined in the [ACA] regarding network adequacy remain insufficient and require further delineation and regulation with longitudinal monitoring of progress to ensure that the one in six Americans suffering from mental illness each year can access appropriate and timely care.” – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.