Health insurers are calling out what they view as critical "operational flaws" in proposed updates to mental health parity requirements.

This summer, the Biden administration pitched regulatory updates to existing parity laws to ensure that health plans are complying with the requirements. Under the rules proposed jointly by the departments of Health and Human Services, Labor and the Treasury, payers would need to evaluate their prior authorization protocols as well as evaluate out-of-network reimbursement to prevent unnecessary costs for members.

AHIP said in submitted comments (PDF) that its members fear the regulatory updates would not necessarily lead to enhanced access to mental health but could institute onerous compliance requirements.

"Essential components" of the proposal clash with state laws or are "vague or entirely undefined," AHIP wrote, and a number of requirements create compliance tests for payers "that cannot be realistically passed."

"If the proposed rules were finalized, it is highly unlikely anyone who today is unable to obtain mental health care would be in any better position to do so," AHIP wrote.

AHIP is urging the feds to withdraw the proposals and start again, gathering feedback from stakeholders in the industry.

The landmark Mental Health Parity and Addiction Equity Act went into law in 2008, requiring that insurers cover key mental health services at parity with medical services. Access, however, remains a critical struggle, particularly for people in commercial plans.

The goal of the proposal, the White House said in July, is to close some of those coverage gaps and hold payers more accountable for the quality of their mental health networks. Provider organizations, including the American Medical Association and the American Hospital Association, cheered the updates.

The regulation received more than 9,500 comments in total.

The Blue Cross Blue Shield Association (BCBSA) echoed AHIP in its comments, arguing that additional clarity around the changes is necessary. The organization said it could lead patients to care that is not recommended, worsening outcomes.

“We share the administration’s goal of expanding access to affordable mental health support, but we’re concerned it could become harder—not easier—for patients to get the care they need,” said David Merritt, BCBSA’s senior vice president of policy and advocacy, in a statement.

“This rule could push us in the wrong direction by forcing health plans to remove important protections that ensure patients are receiving safe, medically necessary, effective care," Merritt added. "We’ll continue to work with our partners, the administration and Congress to improve both access and quality for Americans.”

The Alliance for Community Health Plans said the updates create "an entirely new regulatory schema" that would actually impede insurers looking to address mental health parity.

The ERISA Industry Committee, or ERIC, said many of the proposals "reflect an overreach of agency authority under the statute" and that they would be burdensome for employer-sponsored health plans. The changes, ERIC said, could drive up costs for families and force significant changes to benefit designs.

“Unfortunately, the proposed regulations are so unworkable, it is unclear how compliance could ever be achieved while continuing to offer these important benefits," said James Gelfand, CEO of ERIC, in a statement. "The Departments’ proposals are written in a way that sets plans up to fail."