Final Rules Issued Strengthening Access to Mental-health, Substance-use-disorder Benefits
WASHINGTON, D.C. — As part of the Biden-Harris administration’s effort to ensure more than 150 million people with private health coverage have greater access to mental-health and substance-use-disorder care, the departments of Labor, Health, and Human Services and the U.S. Treasury took significant action by issuing final rules to clarify and strengthen protections to expand equitable access to these benefits as compared to medical and surgical benefits, and reduce barriers to accessing these services.
“Like medical care, mental healthcare is vital to the well-being of America’s workers,” acting Secretary of Labor Julie Su said, adding that the final rules “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 build on the departments’ commitment to achieving the full promise of the Mental Health Parity and Addiction Equity Act of 2008, which requires group health plans and health-insurance issuers offering group and individual health-insurance coverage with mental-health or substance-use-disorder benefits to cover those benefits in parity with medical and surgical benefits, without imposing greater restrictions on mental-health or substance-use-disorder benefits as compared to medical and surgical benefits. More than 15 years after the law’s enactment, the departments’ enforcement efforts have shown that many still encounter barriers to accessing mental-health and substance-use-disorder care as compared to medical and surgical care under their health plan or coverage.
“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 Lisa Gomez, assistant secretary for Employee Benefits Security. “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 new rules add additional protections against more restrictive, non-quantitative treatment limitations for mental-health and substance-use-disorder benefits as compared to medical or surgical benefits. Non-quantitative treatment limitations are requirements that limit the scope or duration of benefits, such as prior authorization requirements, step therapy, and standards for provider admission to participate in a network.
The final rules also prohibit plans from using biased or non-objective information and sources that might negatively impact access to mental-health and substance-use-disorder care when designing and applying a non-quantitative treatment limitation.
The final rules make clear that health plans and insurers must evaluate the impact of their non-quantitative treatment limitations on access to mental-health and substance-use-disorder benefits as compared to medical and surgical benefits and provide additional clarity regarding documentation requirements.
The newly issued rules also require plans and issuers to collect and evaluate data related to the non-quantitative treatment limitations they place on mental-health and substance-use-disorder care and make changes if the data shows they are providing insufficient access. This change will help pinpoint harmful limitations in individuals’ health coverage and remove barriers to access. In addition, the rules give special emphasis to the careful design and management of provider networks to strengthen access to mental-health and substance-use- disorder care.