New Rules Aim to Strengthen Mental Health and Addiction Coverage
In what the US Government is calling an "important step in addressing the nation's mental health crisis," the Department of Labor and Treasury have proposed new rules aimed at better ensuring that people seeking coverage for mental health and substance use disorder can access treatment as easily as people seeking coverage for medical treatments.
“Mental health care is as important to the well-being of America’s workers as medical care, and we must eliminate barriers to getting people the lifesaving care that they often need,” said Acting Secretary of Labor Julie Su, in a statement.
The proposed rules seek to fully protect the rights of people seeking mental health and substance use disorder benefits and provide clear guidance to plans and issuers on how to comply with the law’s requirements. In developing their proposals, the departments drew from their combined and individual experiences in enforcing the act and in working with plans and issuers, as well as state regulators.
Enacted in 2008, the Mental Health Parity and Addiction Equity 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.
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, the agency notes.
“HHS believes all Americans should have access to mental health and substance use disorder treatment, whenever and however they need it,” said HHS Secretary Xavier Becerra, in a statement. “In support of the President’s Unity Agenda, we continue to take actions to address the nation’s mental health crisis. We are ensuring that mental health is treated no differently than physical health and people in need of services have equitable access to care.”
The Department of Labor, in consultation with the Departments of Health and Human Services and the Treasury, 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 and requests input on the development of an enforcement safe harbor for plans and issuers that submit data indicating that 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 Health and Human Services’ Centers for Medicare and Medicaid Services issued a joint fact sheet on the Mental Health Parity and Addiction Equity Act 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 and create parity in treatment limitations, such as network composition standards and prior authorizations, for people seeking mental health and substance use disorder treatment.
With the release of the Comparative Analysis Report to Congress, the departments are providing information on their continued enforcement efforts related to nonquantitative treatment limitations and the comparative analyses that health plans and health insurance issuers must provide upon request to show compliance with parity requirements. The report also identifies plans and issuers that failed to comply with the applicable requirements of the Mental Health Parity and Addiction Equity Act.
“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. “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.”
“Providing equitable access to health care services for everyone is vital, particularly for those in need of mental health and substance use disorder treatment,” said Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure. “CMS, working in partnership with other agencies, continues to remove barriers and expand access to critical services. This rule is a demonstration of the administration’s commitment to parity between physical and mental health services and helping to ensure people get the care they need.”
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