Proposed rules build on Mental Health Parity and Addiction Equity Act
Insurers are prohibited from imposing copayments, prior authorization and other requirements that are more restrictive than medical benefits.
Photo: Basak Gurbuz Derman/Getty Images
The departments of Labor, Health and Human Services and the Treasury have proposed new rules meant to better ensure that those seeking coverage for mental health and substance use disorder can access treatment more easily – as easily as, say, seeking coverage for medical treatments.
As part of this effort, the departments are eyeing the Mental Health Parity and Addiction Equity Act. Enacted in 2008, the act aims to make sure people seeking mental health and substance use disorder care do not face greater barriers to treatment than those faced by people seeking treatment for medical and surgical conditions.
Generally, the act prohibits private health insurance companies from imposing copayments, prior authorization and other requirements on mental health or substance use disorder benefits that are more restrictive than those imposed on medical and surgical benefits.
Yet despite the law's existence, people seeking coverage for mental health and substance use disorder care continue to face greater barriers when seeking benefits for that than when seeking medical or surgical benefits, said HHS Secretary Xavier Becerra.
"HHS believes all Americans should have access to mental health and substance use disorder treatment, whenever and however they need it," he said.
WHAT'S THE IMPACT?
The proposed rules seek to more fully protect the rights of those seeking such benefits, and provide clearer guidance to plans and issuers on how to comply with the law's requirements. In developing their proposals, the departments said they drew from their combined and individual experiences in enforcing the act and in working with plans and issuers, as well as state regulators.
The Department of Labor, in consultation with the departments of Treasury and HHS, also issued a technical release that requests public feedback on proposed new data requirements for limitations related to the composition of a health plan's or issuer's network.
The technical release seeks public comment to inform guidance for proposed data collection and evaluation requirements for nonquantitative treatment limitations related to network composition. It also requests input on the development of an enforcement safe harbor for plans and issuers that submit data indicating their networks of mental health and substance use disorder providers are comparable to networks for medical/surgical providers.
The departments also released the second Mental Health Parity and Addiction Equity Act's Comparative Analysis Report to Congress, as required by federal law.
At the same time, the Department of Labor's Employee Benefits Security Administration and HHS' Centers for Medicare and Medicaid Services issued a joint fact sheet on the law's enforcement results for cases closed in fiscal year 2022.
With the proposed rules and technical release, the departments aim to promote changes in network composition and plans' and issuers' medical management techniques to make mental health and substance use disorder provider networks more accessible. The administration also seeks to create parity in treatment limitations, such as network composition standards and prior authorizations, for people seeking this type of care.
THE LARGER TREND
While 50% of adults with a behavioral condition do not receive treatment, a robust ecosystem inclusive of early identification, along with personalized care pathways with patient to provider matching, can result in improved outcomes, according to Evernorth research published in June.
The demand for behavioral health providers continues to grow. Evernorth's analysis finds the prevalence of behavioral health conditions grew by 4% from 2021 to 2022. The analysis, which looks at anonymized and aggregated claims data of six million people from 2021 to 2022, finds that increases in prevalence vary by condition, with the largest occurring within attention-deficit hyperactive disorder (ADHD), personality disorder and autism spectrum disorder.
The data also shows that the 22% of patients with a diagnosed behavioral condition drive 41% of total healthcare spend for the entire population.
A KFF analysis from January showed the mental health crisis is disproportionately straining Medicaid, in part because behavioral health services cost the federal program more than for other payers.
In addition, workforce challenges contribute to barriers in access to care. Nearly half the U.S. population – 47%, or 158 million people – live in a mental health workforce-shortage area. Workforce challenges are widespread, and go beyond Medicaid, but shortages may be exacerbated in Medicaid, according to the analysis.
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
