Better Mental Health Care for Americans Act, Sec. 203

Summary

Amends Section 1851(d)(4) of the Social Security Act to include provisions for behavioral health information starting in 2025.

Requires the provision of information on access to in-network behavioral health providers, including average wait times for new patient appointments and data on provider participation agreements.

Mandates disclosure of payment request statistics for mental health or substance use disorder services, specifying the percentage handled by in-network versus out-of-network providers.

Requires reporting on the number and percentage of denials for prior authorization or payment for mental health services compared to non-mental health services, categorized by denial type and service type.

Specifies the use of decision support, AI, machine learning, clinical decision-making, or other technologies in denial processes, with comparisons to similar physical health conditions.

Aims to promote informed choice by enhancing transparency in behavioral health service coverage.

Amends the Social Security Act to provide behavioral health coverage information, including provider access and denial statistics.

SEC. 203. PROVIDING INFORMATION ON BEHAVIORAL HEALTH COVERAGE TO PROMOTE INFORMED CHOICE. Section 1851(d)(4) of the Social Security Act (42 U.S.C. 1395w–21(d)(4)) is amended by adding at the end the following new subparagraph: “(F) BEHAVIORAL HEALTH INFORMATION.—For 2025 and subsequent plan years, to the extent available, the following information with respect to the preceding plan year: “(i) Information on access to in-network behavioral health providers, disaggregated by those who prescribe and those who offer mental health or substance use disorder services, including— “(I) the average wait time (as defined by the Secretary) for an appointment for a new patient with an in-network provider for mental health or substance disorder services; “(II) the total number and percentage of providers who have participation agreements with the organization who submitted at least one request for payment for a mental health or substance use disorder service during a 6 month period (or other period specified by the Secretary); and “(III) the percentage of requests for payment for mental health or substance use disorder services that were submitted by— “(aa) in-network providers; and “(bb) out-of-network providers. “(ii) Information on the number of denials of prior authorization requests or denials of payment for mental health or substance use disorder services compared to non-mental health and substance use disorder services overall, categorized by the type of denial and by the type of service, as defined by the Secretary, including— “(I) the number and percent of such denials by the number of days to denial, the reason for denial, and the utilization of decision support technology, artificial intelligence technology, machine-learning technology, clinical decision-making technology, or any other technology specified by the Secretary; and “(II) the number and percent of such denials with respect to a mental health or substance use disorder service compared to such denials with respect to items and services for a similar physical health condition (such as depression compared to diabetes) by the number of days to denial, the reason for denial, and the utilization of decision support technology, artificial intelligence technology, machine-learning technology, clinical decision-making technology, or any other technology specified by the Secretary.”.