Overview
Title
To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require that group health plans and health insurance issuers offering group or individual health insurance that provide coverage for mental health services and substance use disorder services provide such services without the imposition of cost-sharing from the diagnosis of pregnancy through the 1-year period following such pregnancy, and for other purposes.
ELI5 AI
H.R. 8390 is a bill that wants to make sure people who are having a baby, and for a year after, can get help for mental health and addiction without having to pay extra, just like seeing a doctor.
Summary AI
H.R. 8390, known as the "Mental Health and Making Access More Affordable Act of 2024," aims to change U.S. laws to ensure that health insurance plans covering mental health and substance use disorder services offer these services without additional costs for pregnant and postpartum individuals. This coverage would apply from the time of pregnancy diagnosis and extend through the first year after childbirth. The bill proposes amendments to several acts, including the Public Health Service Act and the Employee Retirement Income Security Act, and would apply to both in-person and telehealth services. These changes would take effect for insurance plans starting two years after the bill is enacted.
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AnalysisAI
Overview of the Bill
This proposed legislation, titled the "Mental Health and Making Access More Affordable Act of 2024," aims to amend several existing laws, including the Public Health Service Act, the Employee Retirement Income Security Act (ERISA) of 1974, and the Internal Revenue Code of 1986. Its central objective is to mandate that group health plans and insurance issuers offer mental health and substance use disorder services without cost-sharing for pregnant and postpartum individuals. This means that from the point of pregnancy diagnosis until one year post-pregnancy, these individuals should not face additional out-of-pocket expenses for these specific health services when provided by in-network providers.
Summary of Significant Issues
Several key issues arise from this bill:
Implementation Timeline: The bill sets a timeline stating that changes will take effect two years post-enactment, potentially delaying benefits for affected individuals who need immediate support.
Oversight and Enforcement: The bill does not specify which entities will oversee and enforce the new non-cost-sharing mandates, leaving potential gaps in accountability and compliance.
Definitions and Clarity: There is a reliance on terms and definitions from other sections and laws (e.g., 'telehealth service' and 'diagnosis of pregnancy'), which might not be immediately accessible or clear to everyone, adding a layer of complexity.
Financial Implications for Insurers: The removal of cost-sharing could lead to financial impacts on insurance providers that might result in increased premiums or other cost-shifting measures, though the bill does not address these potential outcomes.
Evaluation and Effectiveness: There is no explicit plan or metrics included to evaluate how effectively the changes improve mental health and substance use service accessibility for the target group.
Impact on the Public
Broadly, the bill could help improve access to essential mental health and substance use disorder services for pregnant and postpartum individuals by removing financial barriers. This has the potential to lead to better health outcomes, reducing stress and financial burden during a critical period.
Specific Stakeholder Impacts:
Pregnant and Postpartum Individuals: This group will directly benefit from reduced financial burdens, enhancing their ability to seek necessary health services during and after pregnancy.
Insurance Providers: They may face challenges due to potential increased usage of covered services without copayments, which could lead to financial adjustments such as raising premiums or reducing other benefits.
Healthcare Providers: Especially those providing mental health and substance use disorder treatments, might see an increase in patients seeking services due to removed financial barriers, necessitating adjustments in service availability or capacity.
Policymakers and Regulators: They will need to address the oversight and enforcement gaps to ensure compliance and that the intended benefits reach the target population effectively.
Conclusion
While the bill's objectives align with positive health outcomes by making mental health services more accessible, some challenges need addressing. These include the timing of its implementation, oversight concerns, clarity in definitions, and addressing the financial impacts on insurers and stakeholders. Effective resolution of these issues will be crucial for translating legislative intent into meaningful improvements in health access and equity.
Issues
The bill lacks explicit provisions for oversight and enforcement of the non-cost sharing requirements, which could lead to gaps in implementation and oversight, as noted in Section 2.
The financial impact on insurance providers due to the removal of cost-sharing provisions is not addressed, potentially leading to increased premiums or other financial shifts, as highlighted in Section 2.
The timeline for implementation applies to plan years beginning two years after enactment, which may delay needed cost-sharing relief for pregnant and postpartum individuals, as discussed in Section 726.
The definition of 'telehealth service' refers to an existing act without providing a summary or definition within the bill, potentially reducing clarity for those unfamiliar with the reference, as noted in Sections 2 and 9826.
There is ambiguity regarding the definition of 'diagnosis of pregnancy' since it is deferred to 'as defined by the Secretary' without a specified definition, possibly leading to varied implementations, as mentioned in Section 2.
The sections referring to 'mental health services' and 'substance use disorder services' definitions point to other sections, which can be inconvenient and create confusion if those definitions aren't clear, as pointed out in Sections 726 and 9826.
The bill does not provide a clear metric or evaluation plan to assess the effectiveness of the policy changes on mental health and substance use disorder service accessibility for pregnant and postpartum individuals, as raised in Section 2.
Sections
Sections are presented as they are annotated in the original legislative text. Any missing headers, numbers, or non-consecutive order is due to the original text.
1. Short title Read Opens in new tab
Summary AI
The section allows the Act to be referred to as the “Mental Health and Making Access More Affordable Act of 2024” or the “Mental Health and MAMA Act of 2024”.
2. Cost sharing with respect to mental health services and substance use disorder services for pregnant and postpartum individuals Read Opens in new tab
Summary AI
The section mandates that, starting two years after its enactment, group health plans and health insurance issuers must eliminate cost sharing for mental health and substance use disorder services for pregnant and postpartum individuals when provided by in-network providers, covering the period from pregnancy diagnosis until one year after the pregnancy ends. It also defines these services and specifies continuity of care provisions.
2799A–11. Cost sharing requirements with respect to mental health services and substance use disorder services for pregnant and postpartum individuals Read Opens in new tab
Summary AI
In this section, it is stated that group health plans or health insurance issuers must not charge any cost-sharing fees for mental health or substance use disorder services provided to pregnant or postpartum individuals by in-network providers. This rule applies from the diagnosis of pregnancy until one year after the pregnancy ends.
726. Cost sharing requirements with respect to mental health services and substance use disorder services for pregnant and postpartum individuals Read Opens in new tab
Summary AI
Under this section, starting two years after the law is enacted, health plans cannot charge extra fees for mental health and substance use disorder treatments provided by in-network providers to pregnant and postpartum individuals from the time pregnancy is confirmed until one year after their pregnancy ends. The services covered include those delivered via telehealth.
9826. Cost sharing requirements with respect to mental health services and substance use disorder services for pregnant and postpartum individuals Read Opens in new tab
Summary AI
The legislation mandates that from two years after its enactment, any group health plan offering benefits for mental health or substance use disorder services must eliminate cost-sharing for these services when provided by in-network providers to pregnant or postpartum individuals from the pregnancy diagnosis until one year after the pregnancy ends. It defines relevant terms, aligning with existing sections of related health laws.