The Biden Administration has finalized its mental health parity rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addition Equity Act of 2008 (“the Act”). The rules are designed to ensure that health insurance plans comply with the Act’s requirements to provide benefits for mental health and substance use disorder care on parity with benefits for medical and surgical care.
Under the Act, health plans are prohibited from placing more restrictive Nonquantitative Treatment Limitations (“NQTLs”) on mental health and substance use disorder benefits than on medical and surgical benefits. In other words, health plans cannot limit access to mental health or substance use disorder benefits by placing limitations on coverage, such as pre-authorization requirements, out-of-network reimbursement rates, or step therapy, that are not required to access coverage for medical and surgical benefits.
Specifically, the final rules:
- Require health plans to conduct comparative analyses to measure the impact of NQTLs on mental health/substance use benefits and on medical surgical benefits, including standards relating to network composition, out-of-network reimbursement rates, medical management, and prior authorization requirements
- Require health plans to collect and evaluate data to determine whether NQTLs applied to mental health/substance use benefits differ from NQTLs applied to medical/surgical benefits, and to address any material differences
- Prohibit health plans from using discriminatory information, evidence or standards that systematically disfavor access to mental health/substance use benefits compared with medical/surgical benefits when designing NQTLs
- Provide revised and new examples of what health insurers cannot do, such as imposing more restrictive utilization management policies and narrower networks, to make it harder for patients to access mental health and substance use disorder benefits
- Require self-funded non-federal governmental health plans, such as plans offered to state and local government employees, to comply with the Act.
The Administration was prompted to issue the rules in part because a Department of Labor report found that every health plan it reviewed had failed to implement the Act’s parity requirements. In the preamble to the rules, the Departments stated that they expect the rules:
will result in changes to network composition and medical management techniques related to mental health and substance sue disorder care, more robust mental health and substance use disorder provider networks, and fewer and less restrictive prior authorization requirements for individuals seeking mental health and substance use disorder care….
In a press release, Acting Secretary of Labor Julie Su stated: “Like medical care, mental health care is vital to the well-being of America’s workers. 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 need.”
The health insurance industry had opposed the rules and is expected to challenge them in court.
The Department of Labor press releasing announcing the final rules is linked here and the fact sheet regarding the final rules is linked here.