Feds' final rules address equitable access to mental health benefits
The rules are intended to achieve the promise of the Mental Health Parity and Addiction Equity Act of 2008, federal agencies say.
Photo: Basak Gurbuz Derman/Getty Images
In a push to shore up access to mental health and substance use disorder care, the departments of Labor, Health and Human Services and the Treasury have issued final rules meant to clarify protections and expand equitable access to those benefits.
The rules are intended to achieve the promise of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, federal agencies said. The act requires group health plans and health insurance issuers offering group and individual 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, officials said 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."
WHAT'S THE IMPACT?
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, the agencies said.
"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, they said.
The final rules also prohibit plans from using biased or nonobjective information and sources that might negatively impact access to mental health and substance use disorder care when designing and applying a nonquantitative treatment limitation.
Per the rules, 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.
The change is intended to 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.
THE LARGER TREND
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 January 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 January 1, 2026. The new rules also apply to grandfathered and non-grandfathered individual health insurance coverage for policy years beginning on or after January 1, 2026.
On Thursday, September 19, the Department of Labor will hold a compliance assistance webinar and join Treasury and Health and Human Services in providing future guidance on the rules.
ON THE RECORD
Dr. Bruce A. Scott, president, American Medical Association, said, "The AMA commends the Biden-Harris Administration for their commitment to ensuring that the federal Mental Health Parity and Addiction Equity Act (MHPAEA) has the teeth to protect patients from health insurance company actions that unfairly and too-often discriminatorily restrict access to mental health and substance use disorder care. While the AMA continues to evaluate the final rule, the AMA strongly supports multiple provisions that will help increase transparency, oversight and enforcement of MHPAEA in areas such as prior authorization and network adequacy. Health plans have violated MHPAEA for more than 15 years, and this final rule is a step in the right direction to protect patients and hold health plans accountable for those failures."
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
