Biden Administration Issues Final Rules to Improve Access to Mental Health Services
The Biden Administration has issued final rules updating the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) to ensure that Americans with health insurance have access to affordable mental health services.
MHPAEA prohibits health insurers and group health plans that provide mental health or substance use disorder (MH/SUD) benefits from imposing barriers on access to MH/SUD benefits that do not apply to medical and surgical benefits. While MHPAEA has helped improve access to mental health services, there is a lack of mental health providers sufficiently covered by health insurance plans, which can require them to pay high out-of-pocket costs for care or prevent them from receiving the care they need. The final rules were issued by the U.S. Departments of Labor, Health and Human Services, and the Treasury to address the problem and improve access to mental health services for more than 150 million Americans with private health coverage.
The new rules provide additional protections against more restrictive, nonquantitative treatment limitations for MH/SUD benefits compared to medical or surgical benefits and prohibit health plans from using biased and non-objective information and sources that could negatively impact access to MH/SUD care when designing and applying a nonquantitative treatment limitation. Nonquantitative treatment limitations are requirements that limit the scope or duration of benefits. They can include prior authorization requirements, step therapy, and standards for provider admission to participate in a network.
The final rules require health plans and insurers to evaluate the impact of their nonquantitative treatment limitations on access to MH/SUD benefits compared to medical/surgical benefits and make changes if the data show they are providing insufficient access.
“The final rules are critical steps forward to making sure that people in need of services can get the care they need without jumping through hoops that they don’t face when trying to get medical or surgical care,” said Department of Labor Assistant Secretary for Employee Benefits Security, Lisa M. Gomez. “Ending the stigma around mental health conditions and substance use disorders calls for a unified effort, and we appreciate the valuable feedback we received from stakeholders – plans, care providers, and participants – in shaping these final rules.”
The final rules generally apply to group health plans and group health insurance coverage on the first day of the first plan year beginning on or after January 1, 2025, with some requirements applying to the first day of the first plan year beginning on or after January 1, 2026. The Departments of Labor, Health and Human Services, and the Treasury have produced a fact sheet providing further information on the final rules.
