The Biden administration has finalized new requirements for health plans to strengthen mental health parity laws for 175 million Americans.
Payers and employer-sponsored plans have been required to cover mental health and substance use benefits the same as they would for medical benefits under the Mental Health Parity and Addiction Equity Act of 2008. Though the law was further strengthened in 2020, mental healthcare access is still fragmented and difficult to access nationwide.
The new rule, introduced in July 2023, will require plans to analyze the outcomes of their mental health coverage policies, including network size, out-of-network payment policies and prior authorization requirements. The new rule clarifies that plans cannot have more restrictive prior authorization standards or narrower networks for mental health services.
The administration is also closing a loophole in the 2008 act that excluded non-federal government health plans from parity standards. Parts of the new policy go into effect in 2025, and others in 2026.
The insurance industry has pushed back against the rule change, with AHIP saying it will "not achieve the goals of increasing access to mental health care or substance use disorder treatment."
"AHIP recognizes there is a necessary role for demonstrating parity, but cautions against an inefficient, vague, and excessive approach that prioritizes analyses of health care coverage over access to health care itself," the trade group wrote.
The Blue Cross Blue Shield Association said the rule could lead to an increase in care that is not clinically recommended.
"This rule could push us in the wrong direction by forcing health plans to remove important protections that ensure patients are receiving safe, medically necessary, effective care. We'll continue to work with our partners, the administration and Congress to improve both access and quality for Americans," David Merritt, senior vice president of policy and advocacy of the BCBSA, said.