Mental health parity in the spotlight under proposed rules

Mental health parity is in the spotlight as the Biden administration wants health insurers to increase their coverage of mental health treatments.

New rules proposed this week would require insurers to require insurers to study whether their customers have equal access to medical and mental health benefits, and to take action if necessary. The Mental Health Parity and Addiction Equity Act requires that insurers provide the same level of coverage for both mental and physical health care. The proposed rules are subject to a public comment period.

If finalized, the regulations would force insurers to study patient outcomes to make sure the physical and mental care benefits are administered equally. Insurers would have to take into account their provider network and reimbursement rates and whether prior authorization is required for care.

The proposed rules would:

• Require health plans to make changes when they are providing inadequate access to mental care. Health plans must evaluate the outcomes of their coverage rules to make sure people have equivalent access between their mental 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.
• Make it clear what health plans can and cannot do. The proposed rules 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 and substance use disorder benefits than their medical benefits. Under the proposed rules, health plans must use similar factors in setting out-of-network payment rates for mental and substance use disorder providers as they do for medical providers.

Enforcement of the rule will fall to the departments of Labor, Treasury and Health and Human Services, an administration official said.