On September 9, the departments of Labor, Health and Human Services and the Treasury issued final rules to clarify and strengthen protections to expand access to mental benefits to reduce barriers to accessing these services.
“Like medical care, mental health care is vital to the well-being of America’s workers,” said Acting Secretary of Labor Julie Su, in a statement. “The final rules issued today make it easier for people living with mental health conditions and substance use disorders to get the life-saving care they often need.”
The new rules add additional protections against more restrictive, nonquantitative treatment limitations for mental health and substance use disorder benefits as compared to medical or surgical benefits. Nonquantitative treatment limitations are requirements that limit the scope or duration of benefits, such as prior authorization requirements, step therapy and standards for provider admission to participate in a network.
The final rules also prohibit plans from using biased or non-objective information and sources that might negatively impact access to mental health and substance use disorder care when designing and applying a nonquantitative treatment limitation.
“Simply put, getting care for anxiety should be as easy as getting medical help for an injured shoulder, and getting medication to treat depression should be as simple as getting medication to treat high cholesterol,” said Assistant Secretary for Employee Benefits Security, Lisa M. Gomez, in a statement.
The rules build on the Mental Health Parity and Addiction Equity Act of 2008. The act requires group health plans and health insurance issuers offering group and individual health insurance coverage that offer mental health or substance use disorder benefits to cover those benefits in parity with medical and surgical benefits, without imposing greater restrictions on mental health or substance use disorder benefits as compared to medical and surgical benefits.
More than 15 years after the law’s enactment, the departments’ enforcement efforts have shown that many still encounter barriers to accessing mental health and substance use disorder care as compared to medical and surgical care under their health plan or coverage.
“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 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.”
The final rules make clear that health plans and insurers must evaluate the impact of their nonquantitative treatment limitations on access to mental health and substance use disorder benefits as compared to medical/surgical benefits and provide additional clarity regarding documentation requirements added to MHPAEA by the Consolidated Appropriations Act of 2021.
The newly issued rules also require plans and issuers to collect and evaluate data related to the nonquantitative treatment limitations they place on mental health and substance use disorder care and make changes if the data shows they are providing insufficient access. This change will help pinpoint harmful limitations in individuals’ health coverage and remove barriers to access. In addition, the rules give special emphasis to the careful design and management of provider networks to strengthen access to mental health and substance use disorder care.
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 that may take more time to implement apply on the first day of the first plan year beginning on or after Jan. 1, 2026. The new rules also apply to grandfathered and non-grandfathered individual health insurance coverage for policy years beginning on or after Jan. 1, 2026.