The Biden administration on Sept. 9 said it is finalizing a set of rules designed to eliminate loopholes and improve funding among insurers and health plans for mental healthcare services.
The rules are jointly issued from the Departments of Labor, Health and Human Services, and the Treasury and meant to strengthen the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, a federal law that prevents health insurers and group health plans from imposing more restrictive limitations on mental health and substance use disorder benefits compared to medical or surgical benefits.
The Biden administration proposed the rules in July 2023, receiving over 9,500 public comments. The administration noted at the time that insurers often make accessing mental healthcare difficult, forcing millions to seek out-of-network treatment at higher costs, pay out of pocket or forgo care altogether.
HHS flagged weak compliance with MHPAEA among health insurers and plans in its 2022 report to Congress, with plans "too often" having not completed or even started comparative analyses of non-quantitative treatment limitations (NQTLs) required under the law until the Employee Benefits Security Administration requested them.
Comparative analyses of NQTLs compare how non-numerical restrictions on treatment, like approval processes or network access, are applied to mental health and substance use disorder benefits versus medical benefits.
Here are seven things to know about "Requirements Related to the Mental Health Parity and Addiction Equity Act," issued Sept. 9 and found in full here:
1. The rule requires more than 200 additional health plans to comply with MHPAEA, providing critical protections to 120,000 consumers. This is an enhancement to the 2008 MHPAEA, which did not require non-federal governmental health plans to comply with its requirements. This set of rules sunsets that measure for optional compliance.
2. The rule explicitly prohibits health plans from using more restrictive prior authorization or narrower networks to make it harder for people to access mental health and substance use disorder benefits than their medical benefits.
3. The rule requires insurers and health plans "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/surgical benefits that result from NQTLs. The rule also addresses the shortcomings identified in the 2022 report to Congress by explicitly listing what is required in health plans' comparative analyses of NQTLs.
4. If a plan or issuer receives a final determination that an NQTL is not in compliance with the comparative analysis requirements, the relevant department may direct the plan or issuer to not impose the NQTL with respect to MH/SUD benefits unless and until the plan or issuer can show they are following the rules or take steps to fix the issue.
5. The final rules generally take effect for group health plans and group insurance coverage on the first day of the first plan year beginning on or after Jan. 1, 2025. Some specific provisions apply starting Jan. 1, 2026. For individual health insurance coverage, the rules take effect for policy years beginning on or after Jan. 1, 2026. Until then, plans and issuers must continue complying with existing regulations, including the 2021 MHPAEA amendments under the Consolidated Appropriations Act.
6. Insurers are expected to oppose the new rule, as many voiced objections to the proposed regulations last fall.
"The fundamental challenge before us is a significant increase in demand for [mental health/substance use disorder] treatment that has far outpaced the number of available licensed providers to adequately meet that demand," America's Health Insurance Plans noted in its October 2023 comments to HHS challenging the proposed rule. "We are concerned these proposed rules focus on documentation and demonstration of compliance with arbitrary new standards that will do nothing to increase the number of available MH/SUD providers or facilitate access to quality MH/SUD care."
"AHIP recognizes there is a necessary role for demonstrating parity, but cautions against an inefficient, vague, and excessive approach that prioritizes analyses of health care coverage over access to health care itself," the group said. It challenged the finding in HHS' 2022 report to Congress that health plans were ill-prepared to share comparative analyses of benefits, arguing that "continued uncertainty over the scope and interpretation of the Departments in their requests for documentation" resulted in perceived noncompliance.
7. The American Hospital Association voiced support for the proposed rule in its October 2023 comments, making a point to note its perceived need for greater requirements for comparative analyses.
"Plans and issuers have had ample time to build the internal structures necessary to analyze their benefits to ensure compliance with MHPAEA," AHA wrote. "While plans once were able to claim the definition of compliance with NQTLs was too nebulous to understand or apply to their benefit designs, the provisions regarding precisely what must be included in a comparative analysis as proposed in this rule will provide clarity about the appropriate application of these coverage limits."