As part of the Biden-Harris administration’s effort to ensure more than 150 million people with private health coverage have greater access to mental health and substance use disorder care, the departments of Labor, Health and Human Services and the Treasury took significant action recently by issuing final rules to clarify and strengthen protections to expand equitable access to these benefits as compared to medical and surgical benefits and reduce barriers to accessing these services.
“Like medical care, mental health care is vital to the well-being of America’s workers,” said Acting Secretary of Labor Julie Su. “The final rules issued today make it easier for people living with mental health conditions and substance use disorders to get the life-saving care they often need.”
The rules build on the departments’ commitment to achieving the full promise of the Mental Health Parity and Addiction Equity Act of 2008. The act requires group health plans and health insurance issuers offering group and individual health insurance coverage that offer mental health or substance use disorder benefits to cover those benefits in parity with medical and surgical benefits, without imposing greater restrictions on mental health or substance use disorder benefits as compared to medical and surgical benefits. More than 15 years after the law’s enactment, the departments’ enforcement efforts have shown that many still encounter barriers to accessing mental health and substance use disorder care as compared to medical and surgical care under their health plan or coverage.
“The final rules are critical steps forward to making sure that people in need of services can get the care they need without jumping through hoops that they don’t face when trying to get medical or surgical care,” said Assistant Secretary for Employee Benefits Security, Lisa M. Gomez. “Ending the stigma around mental health conditions and substance use disorders calls for a unified effort, and we appreciate the valuable feedback we received from stakeholders – plans, care providers and participants – in shaping these final rules.”
The new rules add additional protections against more restrictive, nonquantitative treatment limitations for mental health and substance use disorder benefits as compared to medical or surgical benefits. Nonquantitative treatment limitations are requirements that limit the scope or duration of benefits, such as prior authorization requirements, step therapy and standards for provider admission to participate in a network.
“Simply put, getting care for anxiety should be as easy as getting medical help for an injured shoulder, and getting medication to treat depression should be as simple as getting medication to treat high cholesterol,” said Gomez.
The final rules also prohibit plans from using biased or non-objective information and sources that might negatively impact access to mental health and substance use disorder care when designing and applying a nonquantitative treatment limitation.
“Health care, whether for physical or behavioral conditions, is health care. No one should receive lesser care for one or the other. That’s the law. The rules we issue today make that clear,” said HHS Secretary Xavier Becerra.
The final rules make clear that health plans and insurers must evaluate the impact of their nonquantitative treatment limitations on access to mental health and substance use disorder benefits as compared to medical/surgical benefits and provide additional clarity regarding documentation requirements added to MHPAEA by the Consolidated Appropriations Act of 2021. The newly issued rules also require plans and issuers to collect and evaluate data related to the nonquantitative treatment limitations they place on mental health and substance use disorder care and make changes if the data shows they are providing insufficient access. This change will help pinpoint harmful limitations in individuals’ health coverage and remove barriers to access. In addition, the rules give special emphasis to the careful design and management of provider networks to strengthen access to mental health and substance use disorder care.
Strengthening mental health and substance use disorder parity protections has been a priority of the Biden-Harris administration and the departments, and it is a critical component of President Biden’s Unity Agenda. The final rules support the aim of improving health equity so that Americans get the care they need and deserve.
Most provisions of the final rules apply generally to group health plans and health insurance issuers that offer group health insurance coverage starting on the first day of the first plan year beginning on or after Jan. 1, 2025, but certain requirements that may take more time to implement apply on the first day of the first plan year beginning on or after Jan. 1, 2026. The new rules also apply to grandfathered and non-grandfathered individual health insurance coverage for policy years beginning on or after Jan. 1, 2026.
On Sept. 19, 2024, the Department of Labor will hold a compliance assistance webinar and join Treasury and HHS in providing future guidance on the rules.
View a fact sheet on the new rules.
In addition, to improve implementation of parity in Medicaid and the Children’s Health Insurance Program, the Centers for Medicare & Medicaid Services have developed a set of templates and instructional guides to help state agencies document compliance with MHPAEA requirements in their Medicaid managed care programs, Medicaid alternative benefit plans and CHIP. These new tools are designed to standardize, streamline and strengthen documentation and review processes to ensure that all beneficiaries have access to appropriate mental health and substance use disorder services. CMS is issuing these Medicaid and CHIP parity compliance tools for public comment at Medicaid.gov.
