The Biden administration announced a final rule on Monday meant to expand access and lower costs for care for mental health and substance use disorders. Most provisions in the rule will apply to group health plans and health insurance issuers for plan years starting January 1 or after.
Under this rule, mental health and substance use disorder care on private insurance plans should be covered at the same level as physical health benefits. That may mean “adding more mental health and substance use professionals to their networks or reducing red tape for providers to deliver care,” according to a White House fact sheet shared with CNN ahead of Monday’s announcement.
“Mental health care is health care. But for far too many Americans, critical care and treatments are out of reach. Today, my Administration is taking action to address our nation’s mental health crisis by ensuring mental health coverage will be covered at the same level as other health care for Americans. There is no reason that breaking your arm should be treated differently than having a mental health condition,” President Joe Biden said in a statement.
The rule reinforces the Mental Health Parity and Addiction Equity Act, known as MHPAEA, a 2008 federal law that requires that insurance plans that cover mental health do so at the same level as physical health. Despite the law, insurers have often made it difficult for people to access in-network mental health care, White House Domestic Policy Adviser Neera Tanden said during a briefing. Instead, people have still paid high costs for mental health care, often needing to go out of network and pay out of pocket.
The rule instructs insurers to evaluate coverage based on several criteria, including the plan’s provider network, how much plans pay for out-of-network coverage and how often prior authorization is required and approved under existing plans, according to the administration.
“No one should have to drain their savings or go into debt to get help for themselves or their loved ones,” Tanden said, adding that the change could help 175 million people with private insurance access care using their own plans.
The final rule will also close a loophole that exempted federally provided health insurance plans from complying with the MHPAEA — a move that requires more than 200 additional health plans to improve mental health care for 120,000 consumers, the administration estimates.