More than 15 years after the Mental Health Parity and Addiction Equity Act was enacted, enforcement efforts by the Departments of Labor, Health and Human Services, and Treasury have shown that many people still encounter barriers to accessing mental health and substance use disorder care compared to medical and surgical care under their health plan or coverage.
On September 9, the departments issued final rules that seek to clarify and strengthen protections to expand equitable access to mental health and substance use disorder care benefits and reduce barriers to accessing these services.
The new rules provide additional protections against more restrictive nonquantitative treatment limitations for mental health and substance use disorder benefits compared to medical or surgical benefits. (Nonquantitative treatment limitations are requirements that limit the scope or duration of benefits, such as prior authorization requirements, step therapy, and standards for admitting providers to participate in a network.)
“Simply put, getting treatment for anxiety should be as easy as getting medical help for an injured shoulder, and getting medication to treat depression should be as simple as getting medication to treat high cholesterol,” said Assistant Secretary for Employee Benefits Security Lisa M. Gomez in a statement.
The final rules prohibit plans from using biased or nonobjective information and sources that may adversely affect access to mental health and substance use disorder care when designing and implementing a nonquantitative treatment limitation.
The new rules also require plans and issuers to collect and evaluate data related to nonquantitative limitations they place on mental health and substance use disorder treatment and to make changes if the data show they are not providing sufficient access. The departments said this change will help identify harmful limitations in people’s health coverage and remove barriers to access. In addition, the rules place a strong emphasis on the careful design and management of provider networks to strengthen access to mental health and substance use disorder care.
Patrick J. Kennedy, a partner at the consulting firm Healthsperien LLC and co-author of the landmark Federal Parity Act while serving in Congress, posted a commentary: “While the rule sets a milestone toward achieving parity, it also serves as a catalytic moment for all stakeholders to come together to address broad system reforms that are necessary to make mental health parity a reality. These include establishing a common framework for measuring quality and outcomes, addressing transparency and access to data, increasing the provider network, incentivizing the use of optimal care settings, and streamlining regulatory environments. Let us join forces to create a future where equitable health care is a reality for all.”
