GAO: Behavioral Health Conditions Increased, Access Decreased During Crisis | Healthcare Innovation

How has the need for and availability of services for mental health and substance use disorders changed during the COVID-19 pandemic? Evidence suggests these conditions increased while access to care decreased, according to a new report from the U.S. Government Accountability Office (GAO).

Researchers noted that in 2019, an estimated 52 million adults in the U.S. were reported to have a mental, behavioral, or emotional disorder, and 20 million people aged 12 or older had a substance use disorder. Experts have expressed concerns that the incidence of behavioral health conditions would increase as a result of stressors associated with the COVID-19 pandemic. Even before the pandemic, longstanding questions have been raised about whether coverage or claims for behavioral health services are denied or delayed at higher rates than those for other health services, researchers outlined in the report.

GAO was asked to examine several issues about the demand for behavioral health services, as well as coverage and payment for these services. As such, GAO first examined what is known about the need for and availability of behavioral health services, and how these have changed during the COVID-19 pandemic; and also what issues selected stakeholders identified regarding the payment of claims for behavioral health services.

For the research, the agency reviewed survey data and other relevant analyses focused on the need for and availability of behavioral health services prior to and during the COVID-19 pandemic. GAO also reviewed reports from two states that compared claims for behavioral health services with those of other health services, interviewed officials from the National Council for Behavioral Health (NCBH), and interviewed officials from hospital associations and insurance regulators in Oregon, Pennsylvania, Texas, and Virginia.

Some of GAO’s key findings include:

Officials GAO interviewed from provider organizations offered anecdotal examples of problems with payments for behavioral health services, including examples suggesting that denials and delays were more common for these services than they were for medical/surgical services. However, most officials were not aware of published data that could confirm their concerns, and data from reports from two states on claims denials either did not support their concerns or were inconclusive, researchers revealed.

What’s more, a report in one state that examined mental health parity—requirements that behavioral health benefits be not more restrictive than medical/surgical benefits—found that the rate of complaints associated with behavioral health services was notably lower than those for medical/surgical services.

GAO theorized that the lack of available data confirming stakeholder concerns could be related to potential challenges consumers and providers face in identifying and reporting mental health parity violations, as the agency has previously reported. Specifically, in 2019, GAO found that complaints were not a reliable indicator of such violations, because consumers may not know about parity requirements or may have privacy concerns related to submitting a complaint.

GAO recommended that the federal agencies involved in the oversight of mental health parity requirements evaluate the effectiveness of their oversight efforts. However, as of March 2021, the agencies had not yet implemented this recommendation, GAO noted.