Because all aspects of the inevitable new rules will be data driven, payors should spend 2024 developing valid data sources and analytic tools for using that data. Health plans should focus on the following data:

• Out-of-network utilization
• Percentage of in-network providers actively submitting claims
• Time and distance standards issued by CMS and states
• Number of network providers accepting new patients
• The proportion of providers in urban and rural areas who participate in the plan’s network
• In-network and out-of-network utilization (total dollar value and number of claims)
• Reimbursement rates

Further, you should consider engaging in the following efforts to shore up any potential network inadequacies or material differences in access to in-network providers:

• Provide greater reimbursement or other inducements to mental health/SUD providers.
• Expand telehealth offerings.
• Expand efforts to help members find in-network providers, including clear and prominent language on websites and in brochures and benefit booklets.
• Conduct outreach to encourage mental health/SUD providers to join the network, including any time a member seeks preauthorization for a service from an out-of-network provider.
• Track exceptions where you provide an in-network level of benefits for out-of-network services.
• Conduct member surveys related to out-of-network requests that would help confirm that members use out-of-network providers for reasons other than inadequate networks.
• Conduct surveys asking members how often they forego treatment or pay out of pocket due to a lack of available in-network providers.
• Ensure that network directories are accurate and reliable.

Engaging in these efforts now will put you in the best position for 2025 and can only help strengthen your current mental health parity compliance efforts. Stay tuned for more details on the proposed new rules in the new year!