Federal Departments Propose Rules to Strengthen Parity Law

The departments of Labor, Health and Human Services (HHS), and Treasury on Tuesday announced a series of rule proposals to strengthen the protections of the Mental Health Parity and Addiction Equity Act to better ensure that individuals seeking coverage for mental health and substance use disorder care can access treatment services as easily as those seeking coverage for medical treatments.

Enacted in 2008, the parity law was designed to stop private health insurers from imposing copayments, prior authorization, and other requirements on mental health or substance use disorder benefits that are more restrictive than their medical and surgical benefit counterparts. The rules proposed on Tuesday provide guidance to health insurers on how to better comply with federal parity law requirements.

“Anyone who has ever lived with a mental health condition or substance use disorder—or who has a friend or family member who has—knows how hard getting through the day can be at times and should not have to be worried about facing obstacles to getting treatment,” Lisa M. Gomez, assistant secretary for employee benefits security, said in a news release.

“Yet, throughout the US, people in need of help continue to encounter illegal restrictions on their mental health and substance use disorder benefits and struggle to find mental health and substance use treatment providers that participate in their plan’s networks. Today’s proposed rulemaking is an important step for the departments and stakeholders to work together to make parity a reality.”

Thomas Britton, PhD, CEO of American Addiction Centers, lauded the proposed rules.

“For too long, providers and consumers of behavioral health services have faced extreme barriers to life saving mental health treatment as a result of insurance plans designed to reduce access to care,” Dr Britton said in a statement emailed to BHE. “The plan designs have led to a portion of the overdose epidemic in the US, and existing parity law has been insufficient to hold carriers responsible to provide the care that consumers need and deserve.

“President Biden’s most recently proposed legislature is a strong and clear step in the right direction. Providers like American Addiction Centers stand in solidarity with the president in his fight to end overdose and the perils of mental illness.”

In conjunction with the proposed parity law enforcement rules, the following 3 related items were also released on Tuesday:

• The Department of Labor, in consultation with HHS and Treasury, issued a technical release seeking public feedback on proposed new data requirements for nonquantitive treatment limitations (NQTLs) related to insurers’ network composition as well as the development of an enforcement safe harbor for insurers that submit data indicating that their networks of mental health and SUD treatment providers are comparable to networks for medical and surgical providers.
• Labor, HHS, and Treasury delivered the second Mental Health Parity and Addiction Equity Act’s Comparative Analysis Report to Congress, as required by federal law. The report details the federal departments’ parity law enforcement efforts and cites issuers who failed to comply with applicable requirements.
• The Department of Labor’s Employee Benefits Security Administration and the Centers for Medicare and Medicaid Services (CMS) released a joint fact sheet chronicling results of parity law enforcement cases closed in fiscal year 2022.

“HHS believes all Americans should have access to mental health and substance use disorder treatment, whenever and however they need it,” said HHS Secretary Xavier Becerra said in the release. “In support of the President’s Unity Agenda, we continue to take actions to address the nation’s mental health crisis. We are ensuring that mental health is treated no differently than physical health and people in need of services have equitable access to care.”  

Reference

Departments of Labor, Health and Human Services, Treasury announce proposed rules to strengthen Mental Health Parity and Addiction Equity Act. News release. US Department of Labor. July 25, 2023. Accessed July 25, 2023.