Groups Urge Biden Administration to Exempt Mental Health From No Surprises Act

The American Psychological Association and 10 other organizations want the Biden administration to exempt mental and behavioral health providers from price transparency and anti-surprise billing rules announced last year.

The letter states, in part, that the rules that require health care providers to provide good-faith cost estimates at the outset of a care interaction impose an undue administrative burden on behavioral health providers.

The signers of the letter also claim that the dispute resolution practices detailed in the rules could likely be abused by payers to reduce reimbursements to behavioral health providers. The letter invokes the arduous advocacy and legislative effort to see payers reimburse behavioral health providers in a comparable way to physical health providers.


“Despite the enactment of the Mental Health Parity and Addiction Equity Act (MHPAEA) over a decade ago, the reality of placing coverage of mental health services on equal footing with their medical counterparts has fallen far short of MHPAEA’s ambitions,” the letter states. “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.”

In December 2020, Donald Trump signed the Consolidated Appropriations Act of 2021 into law. The resolution included bill language called the “No Surprises Act” which, among many things, prohibits the practice of surprise billing — or charging a patient out-of-patient rates at in-network facilities — and requires greater pricing transparency in health care.

In July, September and November 2021, the Center for Medicare & Medicaid Services announced interim final rules that laid out how the No Surprises Act would be enforced; the law took effect on Jan. 1, 2022.


The gist of the movement against surprise billing is trying to clamp down on billing practices at hospitals and other physical health facilities that some deem questionable, such as using providers that are out of a patient’s insurance network when there is some expectation that the care provided would be in-network.

The APA letter claims that behavioral health providers are not the target of the No Surprises Act and claim that the administrative burdens of the new law and rules would inhibit the industry’s ability to address the growing mental health problems in the U.S.

In addition to an exemption, the letter proposes a stay on the enforcement of the rules when it comes to routing behavioral health care. The letter claims that the Biden administration rushed through the rulemaking process and didn’t give adequate time and space for industry input.

“Our providers have a long-standing practice of being transparent about fees with their patients because it is required by their professional ethics,” 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.”

In October, CMS Administrator Chiquita Brooks-LaSure said the organization was committed to bringing reimbursement parity to behavioral health and bolstering behavioral health as a means of achieving greater health equity in the country.

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