The Biden Administration has introduced a new proposed rule aimed at strengthening mental health parity regulations, reinforcing the requirement that health plans provide equal access to behavioral health services. The proposal specifically seeks to clarify how health insurers must evaluate their nonquantitative treatment limitations (NQTLs) and ensure their provider networks are adequate for mental health and substance use disorder (SUD) treatment.
For years, individuals seeking mental health and addiction treatment have faced roadblocks, such as prior authorizations, coverage denials, and difficulty finding in-network providers. These hurdles, many of which are considered NQTLs, have made it challenging for people to access the care they need. NQTLs are policies and practices that influence treatment accessibility but are not directly tied to numerical limits, such as copays or visit caps. Instead, they include restrictions like requiring step therapy, implementing burdensome prior authorization processes, or limiting which treatments are deemed “medically necessary.” The new rule would require insurers to conduct a thorough review of these limitations to ensure they are not more restrictive for behavioral health services than for physical health care under mental health parity regulations.
This initiative is part of a larger effort by the Biden Administration to “make parity a reality.” According to Lisa Gomez, Assistant Secretary for Employee Benefits Security, many Americans still face illegal restrictions on their mental health and substance use benefits. She highlighted the difficulties individuals encounter when trying to find in-network behavioral health providers, a problem that has persisted despite existing mental health parity regulations.
The U.S. Department of Labor sent the proposed rule to the White House’s Office of Management and Budget (OMB) on July 10 for final review before publication. The rule incorporates provisions from multiple legislative efforts and draws on insights from federal agencies that have overseen mental health parity regulations since the last major regulatory update in 2014. The proposal aims to strengthen the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, a law designed to prevent insurers from treating behavioral health coverage differently than physical health coverage. It also addresses specific directives passed by Congress in more recent years to further enforce parity.
If finalized, the proposed rule would:
- Clearly establish that health plans must provide equal access to behavioral health services, ensuring that individuals with mental health or substance use disorders are not subjected to more restrictive coverage limitations than those seeking medical or surgical care.
- Require health insurers to conduct in-depth studies on the impact of their NQTLs and take corrective action if they are found to disproportionately restrict access to behavioral health services.
- Set strict content requirements for comparative analyses of NQTLs, ensuring insurers provide detailed and transparent evaluations of their policies under mental health parity regulations.
- Outline how health plans must make these comparative analyses available to federal agencies, state authorities, and even plan members who request them.
- Update examples of how mental health parity regulations apply to NQTLs, providing clearer guidance for insurers and policymakers.
- Phase out the exemption that allows self-funded, non-federal governmental plans to bypass MHPAEA requirements.
For decades, behavioral health advocates have accused insurers of shortchanging patients by imposing barriers to mental health and substance use treatment. Health plans have often been criticized for lower reimbursement rates for behavioral health providers, leading to network shortages and forcing individuals to seek expensive out-of-network care. Legal battles over mental health parity regulations have played out in courtrooms across the country, with major insurers like United Behavioral Health and Aetna facing lawsuits for denying necessary mental health services. The proposed rule is a direct response to these ongoing issues, aiming to hold insurers accountable for providing equitable coverage.
With the release of the proposed rule, a 60-day public comment period has begun, allowing stakeholders to provide feedback. Additionally, the U.S. Department of the Treasury, the Department of Labor, and the Department of Health and Human Services have issued a technical release seeking input on new data requirements that could help assess the adequacy of health plans’ provider networks. This step reflects a growing recognition of the need for stronger oversight to ensure individuals can access timely and effective mental health and addiction treatment.
If finalized, this rule would represent a significant step toward closing loopholes in mental health parity regulations, helping to ensure that individuals receive the behavioral health care they need without unnecessary restrictions or bureaucratic barriers.
