President Biden announces new landmark rule to strengthen mental and physical health parity requirements and improve mental health care access for more than 150 million Americans

Ensuring robust access to mental health care has been a bipartisan priority for almost 15 years, since the 2008 enactment of the Mental Health Parity and Addiction Equity Act (MHPAEA), a landmark law that called for mental health care benefits covered by health plans to be provided at the same level as physical health care benefits, and which was strengthened on a bipartisan basis in 2020. Yet today, too many Americans still struggle to find and afford the care they need. Of the 21% of adults who had any mental illness in 2020, less than half received mental health care; fewer than one in ten with a substance use disorder received treatment.  Research shows that people with private health coverage have a hard time finding a mental health provider in their health plan’s network, like these two mothers in California.  They struggled to find a therapist to help their children, calling multiple therapists in their plans’ networks, only to find that these providers weren’t accepting new patients or had months long waiting lists. 

Despite the repeated bipartisan efforts aimed at mental health parity, insurers too often make it difficult to access mental health treatment, causing millions of consumers to seek care out-of-network at significantly higher costs and pay out of pocket, or defer care altogether.  One study shows that insured people are well more than twice as likely to be forced  to go out-of-network and pay higher fees for mental health care  than for physical health care. And the problem is getting worse: in recent years, the gap between usage of out-of-network care for mental health and substance use disorder benefits versus physical health benefits increased 85 percent.  As a result, millions of people are paying for out of network care for mental health services they need, like this family in Michigan who spent hundreds of thousands of dollars to treat their son’s depression and anxiety because the specialized care he needed wasn’t close to home and this mother in Rhode Island who had to submit additional paperwork to get care for her daughter when her private insurance company initially denied her treatment. 

President Biden believes mental health is health. As part of his Unity Agenda, he released a comprehensive national strategy to transform how mental health is understood, accessed, treated, and integrated in and out of health care settings. That’s why, today, the President is announcing new actions that would improve and strengthen mental health parity requirements and ensure that more than 150 million Americans with private health insurance can better access mental health benefits under their insurance plan. Today’s proposed rule reinforces MHPAEA’s fundamental goal of ensuring that families have the same access to mental health and substance use benefits as they do physical health benefits. And it would make it easier to get in-network mental health care and eliminate barriers to access that keep people from getting the care they need, when they need it.  Specifically, the proposed rule would:

  • Require health plans to make changes when they are providing inadequate access to mental health care. In 2020, Congress made changes to MHPAEA that require health plans to conduct meaningful comparative analyses that will help ensure that access to mental health and substance use benefits is no more restrictive than to medical benefits.  Today’s proposed rule would make clear that health plans need to evaluate the outcomes of their coverage rules to make sure people have equivalent access between their mental health and medical benefits.  This includes evaluating the health plan’s actual provider network, how much it pays out-of-network providers, and how often prior authorization is required and the rate at which prior authorization requests are denied.  These analyses will show plans where they are failing to meet their requirements under the law, and will require plans to improve access to mental health care – by including more mental health professionals in their networks or reducing red tape to get care – to be in compliance with the law.
  • Make it clear what health plans can and cannot do. The proposed rule will provide specific examples that make clear that health plans cannot use more restrictive prior authorization, other medical management techniques, or narrower networks that make it harder for people to access mental health and substance use disorder benefits than their medical benefits. Under the proposed rule, health plans must use similar factors in setting out-of-network payment rates for mental health and substance use disorder providers as they do for medical providers.
  • Close existing loopholes. When MHPAEA was first enacted, it did not require non-federal governmental health plans, like those offered to state and local government employees, to comply with its requirements. Today’s proposed rule would close that loophole and codify Congressional changes made to MHPAEA by requiring more than 200 additional health plans to comply with MHPAEA, providing critical protections to 90,000 consumers. 

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.  In addition to announcing the proposed rule, the President also announced the Administration’s intention to issue a request for information on how it can best work with states to ensure compliance with MHPAEA’s critical protections for the millions of Medicaid beneficiaries enrolled in private Medicaid health plans.

These actions are the latest in a series of steps the Administration has taken to tackle the mental health care crisis, including:

  • Advancing access to services in Medicare. The Administration recently issued proposed rules that, if finalized, would expand access to mental health and substance use care by covering intensive outpatient services; increasing Medicare rates for crisis care, substance use disorder treatment, and psychotherapy; and allowing more mental health and substance use providers to get paid by Medicare.
  • Enhancing crisis response. The Administration has invested nearly $1 billion into strengthening and expanding the 9-8-8 suicide and crisis lifeline. Earlier this month, the Administration added Spanish text and chat services to the existing LGBTQI+ and veteran specific specialized services 9-8-8 offers, and is also developing video phone services to better serve deaf and hard of hearing individuals in the coming months. 
  • Providing mental health services in schools. The Administration recently updated Medicaid School Claiming and Administrative Guide and proposed a rule that would make it easier for schools to bill Medicaid by streamlining billing processes and permissions.

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