Biden Admin Proposes Mental Health Parity in Private Health Plans

The Biden-Harris Administration has proposed a rule to improve access to mental healthcare for privately insured Americans by establishing mental health parity requirements.

The rule supports the Mental Health Parity and Addiction Equity Act’s (MHPAEA) goal of ensuring that access to mental health and substance use benefits is on par with access to physical health benefits.

The Administration has proposed requiring health plans to make changes when they are providing inadequate access to mental healthcare services.

In 2020, Congress required health plans to conduct analyses to ensure access to mental healthcare and substance use disorder care was not more restrictive than access to medical care. The new policy would mandate plans to evaluate the outcomes of their coverage rules to confirm equal access to mental and physical health benefits.

Health plans would have to evaluate their provider network, how much they reimburse out-of-network providers, how often prior authorization is required, and the rate of prior authorization denials. By assessing this data, health plans can learn what they must do to improve access to mental healthcare in compliance with MHPAEA.

Additionally, the proposed rule spells out what health plans can and cannot do related to utilization management. For example, the rule states that health plans cannot use more restrictive prior authorization, other medical management techniques, or narrower networks that make it harder for members to access mental health and substance use disorder care.

Health plans must also use similar factors in setting out-of-network payment rates for mental healthcare providers as they do for medical providers.

The proposed rule refines certain loopholes in MHPAEA, including the lack of requirement for non-federal governmental health plans to comply with the policies. The rule would codify Congressional changes and require more than 200 additional health plans to follow MHPAEA guidelines, improving access to mental healthcare for 90,000 members.

“With today’s changes, this rule would help increase utilization of mental health and substance use care, ensure comparable payment for mental health care professionals, likely incentivizing more people to join the mental health workforce,” the release stated.

The Administration also plans to request information on the best way to work with states to ensure MHPAEA compliance and solidify care mental healthcare access for Medicaid beneficiaries enrolled in private Medicaid health plans.

The proposed rule is the latest in a series of efforts from the Administration to expand access to mental healthcare and substance use disorder care. The Administration has proposed increasing Medicare rates for crisis care, substance use disorder treatment, and psychotherapy. Additionally, it has invested nearly $1 billion in the 988 suicide and crisis lifeline and increased access to school-based mental health services.