Amid a worsening mental health crisis, the Biden administration is proposing a slew of regulatory changes aimed at improving access to critical care.
In 2008, the landmark Mental Health Parity and Addiction Equity Act went into law, requiring insurers to cover mental health benefits at parity with physical health services. However, access to mental health remains a significant hurdle, and the White House noted in a fact sheet that people enrolled in private insurance often struggle with securing necessary services.
In 2020, the mental health parity law was updated to require that payers conduct analyses that would ensure that mental health and substance abuse treatment benefits are not more restrictive than those for medical care. The proposed rules issued Tuesday aim to clarify this requirement and make it clear to insurers that they must be weighing the outcomes of their policies to measure access barriers.
The rules are issued jointly by the Departments of Health and Human Services, Labor and Treasury.
For example, this means taking a close look at the full provider network and reimbursement for out-of-network providers to avoid onerous costs. Plans should also evaluate their prior authorization protocols, examining how often these requests are required and how often they are denied for mental healthcare.
"These analyses will show plans where they are failing to meet their requirements under the law, and will require plans to improve access to mental health care—by including more mental health professionals in their networks or reducing red tape to get care—to be in compliance with the law," the White House said in the fact sheet.
The regulations will also provide clear examples to insurers of what they can do, and what they can't do. For instance, it will highlight that payers are barred from deploying more restrictive prior authorization, network changes or other utilization management tools that may make it more difficult for members to receive mental healthcare.
Insurers must also deploy similar metrics for out-of-network costs in mental health that they would for medical care, according to the fact sheet.
The White House said the rules would also close a loophole that meant non-federal governmental insurance, or benefits offered to state and local government employees, did not need to meet the mental health parity requirements. This will bring 200 additional health plans into compliance, covering 90,000 people, according to the fact sheet.
“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. “Today’s announcement reaffirms the Biden-Harris administration’s commitment to ensuring equal access to mental health and substance disorder benefits for all workers and improving employee wellness.”
Alongside the rules, the Labor Department issued a technical release seeking feedback on potential new data requirements for insurers related to network compliance with mental health parity laws.