The American Psychological Association (APA), along with ten other prominent behavioral health organizations, has formally petitioned the Biden administration for a Behavioral Health Price Transparency Exemption. This exemption would shield mental and behavioral health providers from recent price transparency and anti-surprise billing rules implemented last year. While these rules aim to protect consumers from unexpected medical bills and improve healthcare cost clarity, behavioral health advocates argue that the administrative requirements are excessive and place significant operational burdens on providers, potentially jeopardizing access to care for millions.
Administrative Burdens Threaten Behavioral Health Providers’ Capacity to Deliver Care
A core issue raised in the letter is the obligation under the new rules for providers to furnish good-faith cost estimates at the outset of care interactions. Behavioral health providers are required to complete and update these estimates anytime there is even a minor change to the treatment plan. The signatories emphasize that this administrative process is time-consuming and detracts from valuable clinical time. In an industry already struggling to meet soaring demand—heightened by the mental health fallout of the COVID-19 pandemic—such burdens risk diminishing the ability of providers to offer timely, effective treatment.
The letter states:
“Requiring clinicians to fill out the [good faith estimate] form and update it every time there is a minor change in the treatment plan that may or may not have an impact on costs takes away from valuable treatment time – which is in extremely high demand as more and more people are struggling with the mental health impact of the COVID pandemic.”
Concerns Over Potential Abuse of Dispute Resolution Processes
Beyond administrative burden, the letter raises alarms about the dispute resolution mechanisms embedded within the rules. These processes, designed to resolve payment disagreements between providers and payers, could be manipulated by insurance companies to systematically reduce reimbursements for behavioral health services. The letter’s signatories warn this would exacerbate already existing financial inequities in behavioral health reimbursement.
They recall the long and arduous advocacy efforts that have sought to ensure behavioral health providers receive fair and comparable payment to their counterparts in physical health. The risk that payers might use dispute resolution to undercut these hard-won gains is deeply troubling to the organizations.
The Persistent Mental Health Parity Gap
The letter underscores the ongoing challenge of achieving true parity between mental health and physical health services under insurance coverage. Despite the Mental Health Parity and Addiction Equity Act (MHPAEA) being enacted over a decade ago, the reality still falls short of the law’s ambitions. According to the letter:
“Research consistently reinforces the everyday experiences of our membership: that mental health providers face higher administrative barriers to coverage and lower reimbursement rates for their services (as compared to medical/surgical providers), while patients often find themselves having to choose from narrower networks of mental health providers.”
This disparity results in significant obstacles for patients seeking mental health care and contributes to inequities in access and outcomes.
Background: The No Surprises Act and Its Implementation
The No Surprises Act, part of the Consolidated Appropriations Act of 2021 signed into law by former President Donald Trump in December 2020, was designed primarily to protect patients from surprise medical bills. Surprise billing often occurs when patients unknowingly receive care from out-of-network providers at in-network facilities, resulting in unexpectedly high charges.
To combat this, the law prohibits surprise billing and mandates that healthcare providers offer upfront good-faith cost estimates. Enforcement rules were issued by the Centers for Medicare & Medicaid Services (CMS) in mid to late 2021, and the law officially took effect on January 1, 2022.
Behavioral Health Providers Are Not the Intended Targets
The APA and its allied organizations argue that behavioral health providers are fundamentally different from physical health providers in the nature of their services and billing practices, and that the No Surprises Act’s primary targets are hospital and emergency care billing practices in physical health settings. The letter contends that the application of these rules to behavioral health is misplaced and fails to consider the operational realities of mental health care.
The letter further asserts that the rushed nature of the rulemaking process did not allow adequate time for behavioral health stakeholders to provide input or for careful tailoring of the rules to their unique context. This omission has led to rules that could stifle the behavioral health sector’s ability to expand and meet the nation’s growing mental health needs.
Calls for Exemption and Enforcement Pause
In response, the letter requests that the Biden administration:
- Exempt behavioral health providers from the price transparency and anti-surprise billing rules
- Implement a stay on enforcement of these rules as they pertain to behavioral health care until further review
- Engage in a more deliberate rulemaking process that includes meaningful input from behavioral health industry representatives
These steps are seen as critical to preventing unintended consequences that could reduce behavioral health service availability.
This advocacy for behavioral health price transparency exemption reflects a broader push to ensure that mental health care regulations do not inadvertently create barriers to access.
Commitment to Transparency and Ethical Billing Practices
While requesting relief from the new regulatory requirements, the letter emphasizes that behavioral health clinicians already maintain a strong tradition of transparency with patients about fees and costs. Such transparency is embedded in their professional ethics and practice standards.
The organizations stress that the new mandates, particularly the continuous updating of good-faith estimates, create unnecessary complexity without corresponding patient benefit. This not only consumes clinician time but could confuse patients given the variable nature of behavioral health treatment plans.
The call for a behavioral health price transparency exemption highlights the need to balance ethical billing practices with practical realities in mental health care.
CMS and the Future of Behavioral Health Parity
CMS Administrator Chiquita Brooks-LaSure has publicly committed the agency to advancing reimbursement parity for behavioral health providers and strengthening behavioral health as a cornerstone of broader health equity goals. This commitment signals recognition of the systemic disparities faced by mental health providers and the critical need to address them.
Ongoing dialogue between regulators, payers, providers, and advocates will be essential to ensure that well-intentioned policies like the No Surprises Act do not inadvertently hinder progress in behavioral health care.
The push for a behavioral health price transparency exemption will likely remain a key topic in these discussions moving forward.
Conclusion: Balancing Consumer Protection with Provider Sustainability
The letter from the APA and allied groups spotlights a vital tension in healthcare policy—balancing consumer protections against surprise billing with the practical realities of delivering mental health care. While price transparency and surprise billing protections are important, regulatory approaches must be calibrated to avoid creating administrative obstacles that diminish provider capacity.
As mental health issues continue to surge nationwide, the behavioral health field needs flexible, supportive policies that enhance—not restrict—access to care. An exemption or delay in applying these rules to behavioral health providers may be a necessary step toward preserving the delicate infrastructure of mental health services at a time when they are needed most.
Advocates will continue to lobby for a behavioral health price transparency exemption to safeguard the future of mental health care delivery.
