New Federal Rules Strengthen Mental Health Parity Enforcement

In July 2023, the federal government announced new rules to ensure that people with mental health and substance use conditions receive the same level of health insurance benefits – and access to services – as people with physical health conditions. This was cause for celebration at MAMH, which has long advocated for stronger enforcement of “parity” as a matter both of fairness and necessity for people with mental health conditions and their families.

Despite parity laws in effect at both the state and federal levels, insurers still too often treat people with behavioral health conditions differently than people with physical health conditions. Unequal "non-quantitative treatment limitations” (or NQTLs) include practices such as lower reimbursement rates for behavioral health providers, preauthorization requirements for behavioral health services, and unequal limits on residential treatment. Recent studies suggest that these practices contribute to people with mental health conditions being forced to seek care outside their health insurance networks, often paying out-of-pocket at significantly higher personal cost – or forgo care altogether.

Last year, the Massachusetts legislature passed a mental health reform law (Chapter 177 of the Acts of 2022) to address longstanding problems, including loopholes in state and federal parity laws. At the federal level, the proposed new rule announced July 25 would strengthen the existing 2008 federal parity law (the Mental Health Parity and Addiction Equity Act, or MHPAEA) in the following ways:

• Require health plans to address problems with access to mental health care. The proposed rule would make clear that health plans need to evaluate the outcomes of comparative analyses between their mental health and medical benefits and, if failing to meet their requirements under the law, improve access to mental health care. Potential outcomes include adding more mental health professionals in their networks or reducing other barriers to care.
• Make it clear what health plans can and cannot do. Under the proposed rule, specific examples will be provided to insurers that make clear that health plans cannot use more restrictive prior authorization procedures, other medical management techniques, or narrower networks that make it harder for people to access behavioral health benefits compared to their medical benefits.
• Close existing loopholes. When first enacted, MHPAEA did not require non-federal government health plans, like those offered to state and local government employees, to comply with its requirements. The proposed rules would close this loophole by requiring more than 200 additional health plans to comply with MHPAEA, providing critical protections to 90,000 consumers.

Holding health plans accountable is critical to helping people get needed care and decreasing the enormous health care and social costs of untreated mental health and substance use conditions. Ensuring access to an array of options for behavioral health services and treatment has never been more important than it is today, and strengthening enforcement is a critical step toward achieving that.