The federal departments of Labor, Health and Human Services, and the Treasury came together to propose rules to ensure that people seeking coverage for mental health and substance use disorder care can access treatment as easily as people seeking care for other types of medical treatment.
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.
“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.”
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.
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 non-quantitative 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.
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 a Comparative Analysis Report to Congress, the departments are providing information on their continued enforcement efforts related to non-quantitative 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.
“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, in a statement “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.”