Final Rules on Equal Coverage for Mental Health Care Receive Mixed Reactions

Photo illustration dated January 2020 of a teenage girl showing signs of mental health issues. PA

The departments of Health and Human Services (HHS), Labor, and the Treasury issued new rules on Sept. 9 requiring health plans to provide the same level of coverage for mental health and substance use disorder (SUD) treatment as they do for medical and surgical conditions. While some praised the move for improving access to mental health care, others expressed concerns about its potential effect on coverage and insurance costs.

The departments say that the more than 530-page final rules aim to address longstanding disparities in health plan coverage of mental health and SUD benefits, according to the agencies, in line with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.

The agencies said in a joint statement that the rules will help achieve the “full promise” of the MHPAEA because after more than 15 years “the departments’ enforcement efforts have shown that many still encounter barriers to accessing mental health and substance use disorder care.”

“Like medical care, mental health care is vital to the well-being of America’s workers,” Acting Secretary of Labor Julie Su said. “The final rules issued today make it easier for people living with mental health conditions and substance use disorders to get the life-saving care they often need.”

The rules will limit the use of “restrictive” nonquantitative treatment limitations, which include measures such as prior authorization requirements, network admission standards, and step therapy for mental health and SUD care, according to a fact sheet from the federal agencies.

The rules also require health plans to collect and review data to ensure they aren’t making it harder to access mental health care than medical care, particularly through policies such as prior authorization.

If they find problems, the insurer must fix them. The rules also set clear guidelines on how to assess and report these practices and who can access the reports.

The rules also formally clarify and implement a provision of the Consolidated Appropriations Act of 2023 that removes the current ability of some self-funded government health plans (non-federal, such as state or local government employee plans) to opt out of complying with the mental health parity rules under the MHPAEA.

“Simply put, getting care for anxiety should be as easy as getting medical help for an injured shoulder,” Assistant Secretary for Employee Benefits Security Lisa M. Gomez said.

Mixed Reactions From Health Industry Stakeholders

Reactions from stakeholders in the health care sector are mixed. Some health care organizations expressed concern that the rules might lead to increased costs and challenges for employers.

In a joint statement, AHIP (formerly America’s Health Insurance Plans), the Association of Behavioral Health and Wellness, Blue Cross Blue Shield Association, and The ERISA Industry Committee (ERIC) said that the final rules could have unintended consequences, potentially leading to higher costs and jeopardizing patient access to care.

“The final [MHPAEA] rule will have severe unintended consequences that will raise costs and jeopardize patients’ access to safe, effective, and medically necessary mental health support,” the groups said in the joint statement.

The group of organizations said that the rules fail to address key issues such as a shortage of mental health providers and expanding telehealth resources.

“This rule promotes none of these solutions. Instead of expanding the workforce or meaningfully improving access to mental health support, the final rule will complicate compliance so much that it will be impossible to operationalize, resulting in worse patient outcomes,” the groups said.

ERIC said that it may sue over the rule.

“As ERIC evaluates this rule and assesses the implications for its member companies, we will consider all possibilities to prevent further harm to employers offering behavioral health benefits, and the employees and families who count on them – up to and including litigation,” the agency said in a separate statement.

Support From Mental Health Advocates

Several mental health advocacy groups praised the final rules for what they say are actions that will close gaps in access to care.

A joint statement by 17 national groups representing people with mental health and SUDs and their clinicians welcomed the rules, saying it was a “significant step to ensure that more people have timely and affordable access to needed mental health and substance use disorder treatment.”

The National Alliance on Mental Illness (NAMI), one of 17 organizations, said the rules will prioritize mental health parity and improve enforcement mechanisms.

Daniel H. Gillison, Jr., CEO of NAMI, said in a separate statement: “Every day, people are faced with unfair and potentially deadly consequences when they aren’t able to access the mental health care they need and deserve.

“These changes reflect what we’ve all known for a long time: we need to do better for people with mental health conditions. There is no health care without mental health care.”

The final rules will take effect from Jan. 1, 2025, for most group health plans.