More than 15 years after enactment of the Mental Health Parity and Addiction Equity Act, the departments of Labor, Health & Human Services, and the Treasury’s enforcement efforts have shown that many people 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.
On Sept. 9, the departments issued final rules seeking to clarify and strengthen protections to expand equitable access to mental health and substance use disorder care benefits and reduce barriers to accessing these services.
The new rules offer additional protections against more restrictive, non-quantitative treatment limitations for mental health and substance use disorder benefits as compared to medical or surgical benefits. (Non-quantitative 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.)
“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 said Assistant Secretary for Employee Benefits Security, Lisa M. Gomez, in a statement.
The final rules 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 non-quantitative treatment limitation.
The newly issued rules also require plans and issuers to collect and evaluate data related to the non-quantitative treatment limitations they place on mental health and substance use disorder care and make changes if the data shows they are providing insufficient access. The departments said 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.
Patrick J. Kennedy, a partner at consulting firm Healthsperien LLC and a co-author of the landmark Federal Parity Law while serving in Congress, published a comment: “While the rule sets a marker for achieving parity, it also serves as a catalyzing moment for all stakeholders to come together to address broad based system reforms that are necessary to make mental health parity a reality. These include establishing a common framework for measuring quality and outcomes, addressing data transparency and access, increasing provider pipelines, incentivizing use of optimal settings of care, and streamlining regulatory environments. Let's join forces to create a future where equitable healthcare is a reality for everyone.”
