Andrea Palm, Deputy Secretary | https://www.hhs.gov/about/leadership/andrea-palm.html
The Departments of Labor, Health and Human Services, and the Treasury have issued final rules aimed at improving access to mental health and substance use disorder benefits for over 150 million individuals with private health coverage. This initiative is part of the Biden-Harris administration's broader effort to ensure equitable access to these services.
"Like medical care, mental health care is vital to the well-being of America’s workers," stated Acting Secretary of Labor Julie Su. "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."
These new regulations build on the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, which mandates that group health plans and insurers offering mental health or substance use disorder benefits must provide them in parity with medical and surgical benefits. Despite this law being in place for over 15 years, enforcement efforts have revealed ongoing barriers to accessing mental health and substance use disorder care compared to medical and surgical care.
"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 M. Gomez, Assistant Secretary for Employee Benefits Security. She emphasized the importance of ending stigma around mental health conditions and noted the valuable feedback from stakeholders in shaping these rules.
The new regulations introduce additional protections against restrictive nonquantitative treatment limitations (NQTLs) for mental health and substance use disorder benefits. NQTLs include requirements like prior authorization, step therapy, and standards for provider network admission.
"Simply put, getting care for anxiety should be as easy as getting medical help for an injured shoulder," added Gomez.
Furthermore, plans are prohibited from using biased or non-objective information when designing NQTLs that could negatively impact access to mental health services.
"Health care, whether for physical or behavioral conditions, is healthcare. No one should receive lesser care for one or the other. That’s the law," remarked HHS Secretary Xavier Becerra.
The final rules also mandate that plans evaluate their NQTLs' impact on access to mental health benefits compared to medical/surgical benefits. Plans must collect data related to these limitations and make necessary changes if insufficient access is identified. This measure aims at identifying harmful limitations within individuals' coverage.
Most provisions will apply generally starting January 1, 2025; however, certain requirements will take effect on January 1, 2026. These rules also cover grandfathered individual insurance policies beginning January 1, 2026.
On September 19th, a compliance assistance webinar will be held by the Department of Labor alongside future guidance from Treasury and HHS on implementing these rules.
In addition to these measures under private insurance plans, CMS has developed templates and instructional guides aimed at helping state agencies document compliance with MHPAEA requirements within Medicaid managed care programs and CHIP. These tools are designed to standardize documentation processes ensuring beneficiaries have appropriate access to needed services.
