The Biden administration unveiled new proposed regulations on Tuesday aimed at strengthening existing legislation that mandates insurance companies to provide mental health benefits on par with medical and surgical benefits. An administration official attributed the limited access to mental health care for Americans as the driving force behind these regulations. The Mental Health Parity and Addiction Equity Act (MHPAEA) passed in 2008, eliminating dollar limits on mental health benefits for large group health plans. Despite this, the Biden administration highlighted the ongoing lack of access to mental health services.
In a briefing, White House domestic policy adviser Neera Tanden emphasized the importance of mental health providers and stated that less than half of Americans received the necessary mental health care in 2020. The proposed rules would require health plans to rectify any inadequacies found in their provision of mental health services. To determine these inadequacies, companies’ compliance with legal requirements would be analyzed. It has been observed that insurance companies have not conducted these analyses as thoroughly as expected.
In a report to Congress in 2022, the Departments of Labor, Treasury, and Health and Human Services expressed concern regarding insurance companies’ failure to provide thorough comparative analyses of limitations on mental health benefits. The report revealed that 40 percent of companies requested extensions when asked to provide these analyses. As a result, the Employee Benefits Security Administration concluded that many insurance plans were deficient in meeting their statutory obligations.
Violations of the MHPAEA include refusing to cover out-of-network providers or inpatient benefits for mental health or substance abuse treatment, despite providing these benefits for medical and surgical services. Charging higher premiums for mental health services, imposing broad preauthorization requirements, or not disclosing the criteria for denying benefits are also considered violations. Companies found to be inadequate would be required to take corrective measures such as expanding their network of mental health professionals and reducing administrative barriers to care.
The proposed rules would explicitly prohibit health plans from implementing more restrictive prior authorization requirements, other medical management techniques, or narrower networks to limit access to mental health care. Additionally, the Biden administration aims to close a loophole in the original enactment of the MHPAEA that exempted state and local government employee health plans from complying with federal law.
By codifying changes passed by Congress, the White House estimates that approximately 200 health plans and 90,000 consumers would be affected. Once published in the Federal Register, there will be a 60-day comment period for the public. Regarding enforcement, senior administration officials plan to report non-compliance to Congress and educate consumers on their legal rights relating to mental health coverage. However, no specific penalties for non-compliant insurance companies were disclosed, and the timeline for finalizing the rules remains unclear.
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