By: Christopher A. Parrella, Esq., CPC, CHC, CPCO
Parrella Health Law, Boston, Ma.
A Health Law Defense and Compliance Firm

In the landscape of mental health care in the United States, “ghost networks” present a significant barrier to access. These networks, consisting of healthcare providers listed as in-network but either not taking new patients or no longer participating in the network, exacerbate the challenges patients face in accessing timely and affordable mental health services. Recognizing the urgency of this issue, Senator Tina Smith (D-Minn.) and Senator Ron Wyden (D-Ore.) have introduced the Behavioral Health Network and Directory Improvement Act, a legislative effort aimed at eliminating ghost networks and ensuring parity in mental health care.

The Pervasiveness of Ghost Networks
Ghost networks lead to frustrating dead ends for patients seeking care. A March 2022 report by the Government Accountability Office (GAO) highlighted the impact of inaccurate provider directories on consumer access to services, with instances of mislabeled psychiatrists and incorrect contact information exacerbating the problem. Further studies reveal that a significant percentage of listed psychiatrists are not accepting new patients or are unreachable, leaving patients with limited options and potentially higher out-of-pocket costs for out-of-network care.

The Behavioral Health Network and Directory Improvement Act
The Behavioral Health Network and Directory Improvement Act proposes comprehensive measures to tackle the issue of ghost networks head-on:

• Higher Network Adequacy Standards: The bill aims to strengthen the criteria for evaluating the adequacy of mental health and substance use disorder provider networks. Factors such as provider-to-patient ratios, wait times, geographic accessibility, and the capacity to meet diverse patient needs would be considered, ensuring a genuinely accessible network.
• Directory Accuracy Standards: To ensure that health plan directories reflect up-to-date and accurate information, the bill mandates independent audits of health plans’ provider networks. It also empowers the Department of Labor to issue civil monetary penalties for non-compliance, enhancing accountability.
• Timely Information from Providers: Healthcare providers would be required to regularly update their information with health plans, including their capacity to accept new patients. This measure aims to keep provider directories accurate and reliable.
• Consumer Protections: The establishment of State and Tribal ombudsman programs would educate individuals about their rights under the mental health parity law. Additionally, the bill mandates that health plans inform enrollees affected by ghost networks about their eligibility for refunds for out-of-network charges.
• Improving Mental Health Provider Participation: By directing federal agencies to establish standards for parity in reimbursement rates for mental and physical health services, the bill addresses a critical factor that influences providers’ decisions to join or remain in health plan networks.

The Path Forward
The Behavioral Health Network and Directory Improvement Act represents a crucial step towards enhancing the transparency and reliability of behavioral health services. By addressing the issues of ghost networks and enforcing mental health parity, this legislation aims to make mental health care more accessible and equitable.

At Parrella Health Law, we recognize the importance of such legislative efforts in improving healthcare delivery and compliance. Our team is committed to providing healthcare organizations with the guidance needed to navigate these changes effectively. As this bill progresses, we will continue to monitor its impact on healthcare providers and patients alike, offering insights and support to ensure that our clients are well-prepared to adapt to these critical improvements in behavioral health care access. Please call us at 857-328-0382 or email me directly at cparrella@parrellahealthlaw.com with any questions or comments.

Christopher Parrella, ESQ, CPC, CHC, CPCO, is the founding partner of Parrella Health Law in Boston, Mass. The firm focuses exclusively on healthcare defense and compliance matters. Chris also travels the country on behalf of a wide range of healthcare organizations, lecturing on a variety of health care enforcement and compliance topics. Chris is one of a handful of health care attorney’s that are also Certified Professional Coders (CPC) and is a member of the AAPC’s National Legal Advisory Board and Ethics Committee.  He is also a Certified Professional Compliance Officer (CPCO) and Certified in Health Care Compliance (CHC.)