Proposed rule targets health plan mental health parity compliance

The departments of Labor, Health and Human Services and the Treasury released a proposed rule that seeks to ensure commercial health plans comply with the Mental Health Parity and Addiction Equity Act of 2008, which prohibits them from imposing more restrictive requirements on mental health or substance use disorder benefits than on medical and surgical benefits.

The rule cites examples of prohibited prior authorization and other medical management techniques; proposes standards for determining network composition and out-of-network reimbursement rates; and would require plans to assess and take action to address differences in access to MH/SUD and medical/surgical services. It also would sunset the ability of non-federal government plans to opt out of federal parity requirements; codify standards for comparing the use of Non-Quantitative Treatment Limitations in coverage; and requests feedback on proposed new data requirements related to a health plan’s network composition and NQTLs. 

The agencies will accept comments on the rule for 60 days after its publication in the Federal Register. AHA members will receive a Special Bulletin with more information soon. 

“The AHA is pleased that the Administration is proposing decisive action to limit barriers to access vital mental health and substance use disorder services,” said Molly Smith, AHA’s group vice president of public policy. “By providing clear guidance on how health plans may and may not apply administrative restrictions to behavioral health services, patients are more likely to get the care to which they are entitled under the law, and providers can spend less time on burdensome and unnecessary insurance barriers and more time on patient care. We recognize the challenges to building robust networks of behavioral health providers considering the dire shortages in the behavioral health clinical workforce, and hope that the Administration and others can work to alleviate those challenges in tandem with its ongoing enforcement of the Parity Law.”

In addition to the proposed rule, the departments today released their second annual report to Congress examining health plan compliance with NQTL requirements and associated enforcement actions.