Report
JAMA Health Forum study: few calls to listed mental health clinicians in commercial networks produce an appointment
Published Oct 16, 2026; reported Oct 21; calls placed Oct 2025 – Mar 2026
From Briefing for the week of October 20 – October 26, 2026
What changed
Researchers from Ohio State University and Stanford placed 5,822 secret-shopper calls to psychiatrists and psychologists listed in the largest commercial carrier's online directory in each of five states (Delaware, Montana, New Jersey, Rhode Island and Virginia) between October 2025 and March 2026. Of the 38.7% of calls that could be evaluated, 23.6% led to an appointment with the listed clinician (32.1% counting alternate clinicians at the same number). Directory inaccuracies appeared in 55.6% of evaluable calls, most often wrong contact information (31.0%) and specialty errors (22.2%). Another 21.6% were blocked by clinicians not accepting new patients or not offering appointments. Mean wait for an appointment was 20.5 days. The authors conclude that commercial coverage did not translate into ready access to mental health care. (The article was published a few days before this briefing's window and reported within it.)
Why it matters
It provides measured evidence on the gap between having insurance and getting care, specifically for mental health, and it bears on the directory-accuracy provisions CMS has proposed for Medicare Advantage. Caveats: one large carrier in each of five states, most calls could not be evaluated (mostly unanswered), and results may not generalize nationally or to other insurers.
Sources
Background from our research
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Proposed
CMS proposes rules on Part D PBM compensation, MA provider directories and $0 generics for low-income duals
Released Oct 16, 2026; Federal Register publication scheduled Oct 20; comments due Dec 15; proposed start 2028
From Briefing for the week of October 13 – October 19, 2026
What changed
CMS released a proposed rule (CMS-4214-P) implementing sections 6219, 6220 and 6224 of the Consolidated Appropriations Act, 2026. Per the Federal Register public-inspection copy and CMS's fact sheet, it would (1) set new requirements for PBMs in Part D covering compensation tied to drug utilization, data reporting to plan sponsors and CMS, price-guarantee transparency and disclosure of certain manufacturer-agreement terms, with disgorgement of funds to CMS for violations; (2) require Medicare Advantage plans to verify provider directories at least every 90 days, report an accuracy score, and limit cost sharing to in-network levels for enrollees who relied on inaccurate listings; and (3) cut the generic-drug copay from $1 to $0 for full-benefit dual-eligible people at or below 100% of the federal poverty level. Proposed start dates are plan or contract year 2028, and the directory accuracy scores would be posted publicly for 2029. CMS did not publish savings estimates in the materials reviewed.
Why it matters
The February 2026 law set the statutory outline for PBM reform in Part D; this proposal is where the operating details, definitions and enforcement tools get written, and those details determine whether PBM compensation actually moves away from drug-price-linked payments. The directory provisions address a long-running access problem, since patients often learn a listed provider is not in network only after seeking care. This is a proposal, not a final rule, and the text may change after comment.
Warrants deeper follow-up. Read the PBM remuneration definitions and the disgorgement mechanism closely; compare with state PBM laws already tracked.
Sources
Background from our research
Storylines