Mental Health Parity Rule Lauded by Healthcare Groups

Reviews were generally positive for the final version of the mental health parity rule that the Biden administration released on Monday.

“The Mental Health Parity and Addiction Equity Act (MHPAEA) has been the law for more than a decade and a half, but its protections and benefits for people seeking mental health and substance use care were hampered by a lack of clear oversight and accountability,” Chuck Ingoglia, MSW, president and CEO of the National Council for Mental Wellbeing, said in a statement. “The National Council applauds this rule, which would enhance enforcement of the parity law, holding health care plans responsible to adhere to best practices and provide required access to mental health and substance use care for people who need it.”

The American Medical Association (AMA) was also complimentary. “The AMA commends the Biden-Harris administration for their commitment to ensuring that the federal 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,” said AMA president Bruce Scott, MD, in a statement. “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.”

Among other provisions, the final rule “make[s] it clear that health plans need to evaluate their provider networks, how much they pay out-of-network providers, and how often they require – and deny – prior authorizations,” the White House said in a fact sheet issued Monday. “The outcomes of these evaluations will show plans where they are failing to meet the law’s requirements, and where they will need to make changes to come into compliance, like adding more mental health and substance use professionals to their networks or reducing red tape for providers to deliver care.”

In addition, the rule says that “health plans cannot use more restrictive prior authorization, or other medical management techniques, or narrower networks to make it harder for people to access mental health and substance use disorder benefits” compared with their medical benefits, according to the fact sheet. The same goes for setting out-of-network payment rates for mental health and substance use disorder providers, it added.

President Biden lauded the new rule. “Mental health care is healthcare,” he said in a statement Monday. “But for far too many Americans, critical care and treatments are out of reach. Today, my administration is taking action to address our nation’s mental health crisis by ensuring mental health coverage will be covered at the same level as other health care for Americans. There is no reason that breaking your arm should be treated differently than having a mental health condition. The steps my administration is taking today will dramatically expand access to mental health care in America.”

Mental health insurers expressed some caution about the regulation. “We are concerned that provisions in the final rule, such as the material difference standard and meaningful benefits provisions, go beyond the law’s intent and will create costly compliance hurdles that may negatively impact affordability and access to mental health and substance use disorder care,” Pamela Greenberg said in a statement as president and CEO of the Association for Behavioral Health and Wellness, an association of mental health care plans including Aetna, Optum, and Centene.

However, she did express appreciation that the Biden administration “listened to stakeholders and in particular, did not adopt the proposed cumbersome mathematical tests to determine whether or not health plans were providing parity for non-quantitative treatment limits.”

The new rule’s effectiveness will need to be closely watched, according to Joanna Quigley, MD, associate medical director for child and adolescent outpatient psychiatry and addiction treatment at Michigan Medicine in Ann Arbor. “[T]rue parity for mental and behavioral health care continues to be elusive for many, and interventions that remove barriers during a time of unprecedented demand for mental health care are welcome,” she said in a statement. “It will be very important to monitor implementation of these changes, particularly around the goals of limiting the scope of limits set through prior authorization processes and limits on length or type of treatment settings.”

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 may take more time to implement, the Department of Health and Human Services said in a press release.

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