Behavioral health parity has long been a priority in U.S. legislation, yet nearly three decades after initial efforts, the road to full implementation remains incomplete. With Congress entering the lame-duck session, lawmakers are signaling renewed momentum to advance mental health reforms—including stricter enforcement and clarification of behavioral health parity laws. This renewed focus comes as both payers and providers continue to advocate for meaningful guidance and practical solutions that ensure patients can access to care without undue administrative or financial barriers.
The History of Behavioral Health Parity
The concept of behavioral health parity traces back to the 1990s, when policymakers first recognized the stark discrepancy between insurance coverage for mental health and physical health conditions. Despite incremental reforms over the years, behavioral health services—encompassing mental health treatment, substance use disorder care, and high-acuity interventions—have often remained underfunded, undercovered, or administratively burdensome.
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 was a significant step forward, requiring that limits on mental health or substance use disorder benefits be no more restrictive than limits applied to medical and surgical benefits. However, legal mandates alone could not eliminate the practical barriers that patients face when seeking care, preventing many from accessing care in a timely or affordable manner.
Lawmakers Eye Must-Pass Bills
As the 2025 legislative calendar progresses, bipartisan support for mental health reforms is growing. Senators Bill Cassidy (R-La.) and Ron Wyden (D-Ore.), key members of the Senate Finance Committee, have expressed optimism about including behavioral health provisions in must-pass legislation. Representative Paul Tonko (D-N.Y.) has similarly indicated confidence in advancing critical reforms through the House, particularly via the Restoring Hope for Mental Health and Well-Being Act (H.R. 7666), which passed the House in June with overwhelming bipartisan support (402-20).
These lawmakers are at the forefront of a push to clarify rules around behavioral health parity and improve patients’ access to care. The goal is to ensure that patients can receive the full spectrum of mental health and substance use disorder services—ranging from outpatient therapy to intensive inpatient treatment—without being impeded by insurance limitations or administrative hurdles.
The Payers’ Perspective: Clarity on Compliance
While lawmakers focus on passing legislation, payers are looking for clear guidance on how to comply with existing and forthcoming parity rules. The Consolidated Appropriations Act of 2021 empowered the Department of Labor (DOL) to consider nonquantitative treatment limitations (NQTLs) in its parity enforcement duties and required the department to establish rules on how NQTLs are evaluated for compliance with federal law. Yet, two-plus years later, that guidance has not materialized.
Jim Laughman, president of PerformCare—a behavioral health managed care organization under AmeriHealth Caritas—told Behavioral Health Business, “We’ve been waiting for two-plus years for the Department of Labor to give out some guidance around how parity is measured. We believe very clearly that we’re demonstrating that we’re doing parity, minus that guidance and understanding from what the federal government is looking for.”
PerformCare operates across Medicare, Medicaid, and marketplace plans, and Laughman also serves as treasurer of the Association for Behavioral Health and Wellness (ABHW), a key advocacy organization representing payers. For payers, clear guidance is critical not just to comply with the law, but also to ensure that enforcement mechanisms are consistent and predictable, ultimately supporting patients’ access to care.
In September, the House passed the Mental Health Matters Act, which aims to enhance the DOL’s enforcement authority over parity provisions and make it easier to hold payers accountable for mishandling behavioral health claims. ABHW Government Affairs Vice President Maeghan Gilmore emphasized that clear, comprehensive guidance from the administration is a prerequisite before introducing additional enforcement mechanisms. Without clarity, payers face uncertainty, and enforcement efforts risk being uneven or ineffective, limiting patients’ access to care.
Providers’ Perspective: Easing the Burden on Patients
For providers, the primary concern is ensuring that patients can actually receive the care they need. While parity laws have reduced some administrative burdens—fewer prior authorizations, easier coverage for short-term therapy sessions—many patients still struggle to obtain high-acuity care for conditions such as severe anxiety, eating disorders, or acute substance use crises.
Lauren Conaboy, vice president of national policy at Centerstone, a nonprofit mental health and addiction treatment provider, explained, “Anecdotally, I can think of dozens if not hundreds of stories of people that—when they really needed care for an acute substance use disorder, or an eating disorder, or severe anxiety—just cannot get the level of care they needed without spending their life savings.”
Even commercial health insurance, often viewed as more generous in covering behavioral health services, can create disparities in cost-sharing between primary care and behavioral health. Conaboy noted, “Until we’re in a day where we can go see a psychiatrist or a therapist, and it’s covered … the same as if we were to go to our primary care physician, behavioral health parity won’t be realized, and patients’ access to care remains unequal.”
Administrative burdens—complex claims processes, inconsistent coverage criteria, and paperwork requirements—also deter patients from seeking help. Providers argue that legislation clarifying parity obligations and enforcing compliance could significantly improve access to care, making it easier for patients to get timely treatment when they need it most.
The Real Stakes: Access, Equity, and Outcomes
At its core, behavioral health parity is not simply a matter of insurance compliance or payer reimbursement. It is about equity, access, and outcomes. When patients cannot access care due to cost or administrative hurdles, their conditions often worsen, leading to more intensive, expensive, and prolonged treatment later.
Jennifer Evans, an attorney with the Polsinelli Behavioral Health Law Group, stressed the purpose of parity in a recent webinar: “It’s really about making sure that the payers—whether it’s Medicare, Medicaid, or a commercial payer—[are] not dissuading people from getting access to care through some sort of administrative or financial limitation.”
Behavioral health parity also intersects with broader public health priorities. Substance use disorders, depression, anxiety, and other mental health conditions are leading causes of disability in the United States. Studies consistently show that timely access to care can prevent hospitalizations, reduce emergency department visits, and improve long-term outcomes for individuals and families. Full parity implementation is therefore critical not only for individual patients but also for reducing systemic healthcare costs and improving population health.
Challenges Ahead
Despite growing bipartisan support and legislative momentum, challenges remain. Lawmakers, payers, and providers must navigate complex regulatory frameworks, differing interpretations of parity laws, and the practical realities of healthcare delivery.
For payers, the absence of DOL guidance on NQTLs creates uncertainty in determining whether benefit designs comply with federal law. For providers, even minor discrepancies in coverage, cost-sharing, or administrative requirements can create major barriers for patients’ access to care. Bridging these gaps will require coordinated efforts, clear enforcement guidelines, and ongoing collaboration among federal agencies, legislators, insurers, and care providers.
Looking Ahead: Potential Impacts of New Legislation
If Congress successfully advances behavioral health parity reforms before the end of the year, several outcomes are likely:
- Enhanced Enforcement: Federal agencies may gain additional authority to monitor compliance, investigate violations, and hold payers accountable for denying parity-equivalent coverage.
- Improved Access for Patients: Clear rules and enforcement mechanisms could reduce administrative burdens and financial barriers, significantly improving access to care for high-acuity treatment, residential programs, and outpatient therapy.
- Greater Transparency: Payers may be required to disclose more information about how NQTLs are applied, giving providers and patients better insight into coverage decisions.
- Stronger Bipartisan Momentum: Successful reforms could set a precedent for future collaboration on broader mental health initiatives, including funding for community-based services, telehealth expansion, and integrated care models.
Conclusion
Behavioral health parity is no longer a theoretical goal—it is a pressing need for millions of Americans seeking mental health and substance use disorder treatment. With bipartisan lawmakers like Senators Cassidy and Wyden and Representative Tonko pushing for reforms, and with both providers and payers calling for clarity and actionable guidance, the potential exists for meaningful legislative progress before the end of the year.
Ultimately, achieving true behavioral health parity means more than legal compliance. It requires ensuring that patients can access to care without facing financial strain or administrative obstacles. By combining clear legislative direction with practical enforcement and a focus on patient-centered care, Congress has the opportunity to make parity a reality—not just a policy goal.
