If finalized as proposed, the new actions would ensure that people seeking coverage for mental health and substance use disorder care can access treatment as easily as people seeking coverage for medical treatments.
The proposed rules, announced Tuesday by the departments of Health and Human Services, Labor, and the Treasury, aim to protect the rights of people who seek mental health and substance use disorder benefits and provide guidance to plans and issuers on how to comply with the law’s requirements.
If finalized, the rule would 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.
However, the administration said that despite the law’s existence, people who seek mental health and substance use disorder care continue to face barriers when seeking benefits.
“Anyone who has ever lived with a mental health condition or substance use disorder—or who has a friend or family member who has—knows how hard getting through the day can be at times and should not have to be worried about facing obstacles to getting treatment,” said Assistant Secretary for Employee Benefits Security, Lisa M. Gomez in the announcement. “Yet, throughout the U.S., people in need of help continue to encounter illegal restrictions on their mental health and substance use disorder benefits and struggle to find mental health and substance use treatment providers that participate in their plan’s networks. Today’s proposed rulemaking is an important step for the departments and stakeholders to work together to make parity a reality.”
In a fact sheet, the White House said the proposed rule would:
- Require health plans to make changes when they are providing inadequate access to mental health care. Health plans would need to evaluate the outcomes of their coverage rules to make sure people have equivalent access between their mental health and medical benefits. This includes evaluating the health plan’s actual provider network, how much it pays out-of-network providers, and how often prior authorization is required and the rate at which prior authorization requests are denied. These analyses will show plans where they fail to meet their requirements under the law and will require plans to improve access to mental health care–by including more mental health professionals in their networks or reducing red tape to get care–to be in compliance with the law.
- Provide health plans with specific examples that make clear they cannot use more restrictive prior authorization, other medical management techniques, or narrower networks that make it harder for people to access mental health and substance use disorder benefits than their medical benefits. Under the proposed rule, health plans must use similar factors in setting out-of-network payment rates for mental health and substance use disorder providers as they do for medical providers.
- Close existing loopholes. The administration said that when MHPAEA was first enacted, it did not require non-federal governmental health plans, like those offered to state and local government employees, to comply with its requirements. The proposed rule would close that loophole and codify congressional changes made to MHPAEA by requiring more than 200 additional health plans to comply with MHPAEA, providing critical protections to 90,000 consumers.
In addition to the proposed rule, the Department of Labor issued a technical release that asks for public feedback on proposed new data requirements for limitations related to the composition of a health plan’s or issuer’s network.