H.R. 7227: Mental Health and Making Access More Affordable Act of 2026

The "Mental Health and Making Access More Affordable Act of 2026" aims to enhance access to mental health services and substance use disorder services for pregnant individuals and those in the postpartum period. Here’s a breakdown of its key provisions:

Cost Sharing Requirements

The bill mandates that group health plans and health insurance providers offering both group and individual health insurance must provide coverage for mental health services and substance use disorder services without any cost-sharing requirements. This applies specifically:

• From the diagnosis of pregnancy.
• Through one year following the end of the pregnancy.

This means that individuals seeking these mental health and substance use services will not have to pay deductibles, copayments, or coinsurance when using in-network providers during this specified time frame.

Inclusion of Telehealth Services

The coverage requirements include services provided via telehealth, thus facilitating access to care through remote technologies, which can be especially beneficial for new and expecting mothers.

Continuity of Care

The bill also emphasizes the importance of continuity of care for ongoing treatment. It specifies that if an individual is receiving mental health or substance use disorder services during pregnancy, they can continue to receive those services without interruption even after childbirth for up to one year, as long as they were enrolled in the health plan during that period.

Legislative Amendments

This legislation proposes amendments to several existing laws including:

• The Public Health Service Act
• The Employee Retirement Income Security Act of 1974 (ERISA)
• The Internal Revenue Code of 1986

These amendments are designed to ensure consistent enforcement of the no-cost-sharing requirement across various insurance plans and to ensure that all relevant federal laws reflect these changes.

Implementation Timeline

The provisions will be effective for plan years beginning two years after the enactment of the legislation, allowing time for health plans and insurers to adjust their offerings accordingly.

Additional Provisions for Federal Employees

The bill includes amendments for the Federal Employees Health Benefits Program (FEHBP) to integrate these new cost-sharing requirements into their contracts, further ensuring that federal employees receive similar protections regarding mental health and substance use services during and after pregnancy.

Relevant Companies

• UNH - UnitedHealth Group: As a major provider of health insurance in the U.S., changes in mental health coverage and cost-sharing regulations will directly impact their policy offerings and financial structure.
  
• ANTM - Anthem Inc.: Similar to UnitedHealth Group, Anthem may need to adjust their health plans to comply with the implemented cost-sharing requirements, potentially affecting their pricing and service structure.
  
• CNC - Centene Corporation: As another significant player in the health insurance sector, Centene's approach to mental health services and pregnancy-related care will likely shift in response to these new mandates.