The U.S. Department of Labor has submitted its final rule to overhaul behavioral health regulation. This final rule, currently under review by the White House, represents a major step toward improving mental health and substance use disorder treatment parity. The overhaul of these regulations is in alignment with the Mental Health Parity and Addiction Equity Act (MHPAEA), and its potential impact on both health plans and treatment providers is significant. Although it’s unclear when the rule will be released to the public, the proposed changes could reshape the landscape of mental health treatment in the U.S.
The Proposed Changes: What to Expect
If released as initially proposed, the new rule will primarily address two key areas: non-quantitative treatment limitations (NQTL) and network composition, both of which fall under behavioral health regulation. These changes are designed to close gaps in parity enforcement, ensuring that limitations on mental health and substance use disorder benefits are no more restrictive than those applied to medical/surgical benefits.
This overhaul of behavioral health regulation will be instrumental in ensuring that individuals seeking treatment for mental health or addiction issues have equitable access to care. By establishing clearer rules for applying treatment limitations, these changes aim to provide greater transparency for both insurers and healthcare providers.
Key Areas of Focus
The new rule will focus on improving behavioral health regulation in two main areas:
1. Non-Quantitative Treatment Limitations (NQTL)
NQTLs are restrictions that can prevent individuals from receiving needed care, such as the use of medical necessity criteria, prior authorization, or treatment duration limits. Under the proposed changes, insurers will be required to ensure that these limitations are not more restrictive for behavioral health services than they are for medical or surgical services, which would be a significant shift in behavioral health regulation.
2. Network Composition
Health plan networks for behavioral health services are often smaller or less accessible than those for medical/surgical treatments, resulting in delays or barriers to care. The proposed rule would require health plans to ensure that their behavioral health networks are as robust and accessible as those for other medical services, an important step toward improving behavioral health regulation in the U.S.
The Role of Federal Agencies
The rule, submitted to the Office of Management and Budget (OMB) on July 1, has been developed with input from the Department of Labor, Centers for Medicare & Medicaid Services (CMS), and the Internal Revenue Service (IRS). This collaboration highlights the complexity of the changes to behavioral health regulation and the need for multi-agency input to create balanced, effective rules that protect patients while also being feasible for insurers and healthcare providers.
The proposed rule’s complexity reflects its importance and the significant implications it could have for behavioral health regulation and how insurers handle mental health and substance use disorder treatment.
Reactions from Stakeholders
Behavioral health advocates have largely welcomed the proposed changes, seeing them as a critical step in reducing arbitrary barriers to treatment. The National Council for Mental Wellbeing’s Chuck Ingoglia emphasized that “too often, arbitrary barriers prevent people from getting the mental health and substance use treatment and care they need.” These changes to behavioral health regulation are seen as an opportunity to reinforce the importance of access to care and reduce the disparities between mental health and medical treatment.
However, payer groups argue that the rules are vague and could impose significant administrative burdens. Insurers are calling for clearer guidance on how the new behavioral health regulation will be applied. The debate underscores the challenges of balancing patient access to care with the operational needs of health plans.
Parity: A Long-Standing Challenge
The issue of mental health parity has been a point of contention for nearly three decades, ever since the Mental Health Parity Act of 1996. Over time, laws like the MHPAEA of 2008 have worked to bridge the gap between mental health and medical treatment, but gaps in enforcement have remained. The latest proposed overhaul of behavioral health regulation is a response to these persistent issues and aims to close the remaining gaps in parity enforcement.
With the new rule, behavioral health regulation seeks to ensure that individuals facing mental health and substance use disorders are no longer burdened with arbitrary treatment limitations that have historically made accessing care difficult. The rule would bring clearer enforcement mechanisms to ensure that behavioral health benefits are treated equally to medical benefits.
The Other Major Behavioral Health Debate: Telehealth and Controlled Substances
In addition to the overhaul of behavioral health regulation, another key issue under discussion is the regulation of telehealth and controlled substances. With the expiration of COVID-era telehealth flexibilities, there are growing concerns over how the Drug Enforcement Administration (DEA) will address telehealth for controlled substances. The DEA recently submitted another proposed rule to the OMB, which could have a significant impact on how telehealth services are delivered in the future, particularly for individuals seeking behavioral health treatment.
Looking Ahead
As the final rule moves closer to release, it’s clear that its implications will be far-reaching. The overhaul of behavioral health regulation will affect insurers, healthcare providers, and individuals seeking mental health and substance use disorder treatment. Behavioral health advocates are optimistic that the new rule will help reduce barriers to care and increase access to treatment. However, the ultimate effectiveness of the new regulations will depend on how well they are enforced and whether they strike the right balance between patient access and insurer operational needs.
The final rule represents a critical opportunity to ensure that behavioral health regulation reflects the needs of patients and providers alike. It could provide a blueprint for ensuring parity in treatment and a fairer system for all who need care.
