The final rules, announced Monday by the departments of Health and Human Services, Labor, and the Treasury, aim to strengthen private health coverage for people who seek mental health and substance use disorder care and ensure coverage is in parity with medical and surgical benefits.
The rules, which were proposed in July 2023 and garnered thousands of comments from the public, strengthen the Mental Health Parity and Addition Equity Act (MHPAEA), a law enacted in 2008 that called for health plans that offer mental health care benefits to provide them at the same level as physical health care benefits. The law 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.
Despite the law’s existence, there have been longstanding disparities in coverage between mental health and substance use disorder benefits and medical and surgical benefits. The final rules will amend certain provisions of the MHPAEA regulations as well as create additional regulations.
“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 in a statement. “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.”
According to a fact sheet, the final rules:
- Ensure the MHPAEA protects plan participants, beneficiaries, and enrollees from facing greater restrictions on access to mental health and substance use disorder benefits compared to medical and surgical benefits.
- Reinforce that health plans and issuers cannot use nonquantitative treatment limitations (NQTL)— including prior authorization requirements and other medical management techniques, standards related to network composition, and methodologies to determine out-of-network reimbursement rates— that are more restrictive than the predominant NQTLs applied to all medical and surgical benefits in the same classification.
- Require plans and issuers to collect and evaluate data and take reasonable action, as necessary, to address material differences in access to mental health and substance use disorder benefits as compared to medical and surgical benefits that result from application of NQTLs, where the relevant data suggest that the NQTL contributes to material differences in access.
- Require plans and issuers to collect and evaluate data related to the NQTLs and make necessary changes if the data shows they are providing insufficient access.
- Codify the requirement in MHPAEA, as amended by the Consolidated Appropriations Act, 2021, that health plans and issuers conduct comparative analyses to measure the impact of NQTLs.
- Prohibit plans and issuers from using discriminatory information, evidence, sources, or standards that systematically disfavor or are specifically designed to disfavor access to mental health and substance use disorder benefits as compared to medical and surgical benefits when designing NQTLs.
- Implement the sunset provision for self-funded non-Federal governmental plan elections to opt out of compliance with MHPAEA.
Most provisions of the final rules will go into effect in January 2025; however, certain requirements won’t apply until January 2026.
For more information on the final rules, click here.