Biden-Harris Administration Expands Mental Health Coverage Protections Nationwide

The new rule is designed to close critical gaps that have left millions of Americans struggling to access mental health and substance use disorder care.
Image Credit: Nomad_Soul - stock.adobe.com

The Biden-Harris administration is placing new requirements on health plans to improve access for 175 million Americans with private insurance and ensure mental health care is taken seriously, according to an announcement from The White House.¹

“Mental health care is health care," Biden said in the statement published yesterday. "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. The steps my Administration is taking today will dramatically expand access to mental health care in America.”

The new rule is designed to close critical gaps that have left millions of Americans struggling to access mental health and substance use disorder care. Despite the enactment of the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008, and its subsequent strengthening in 2020, significant barriers remain.

For example, less than half of adults with mental illness received treatment in 2020, while nearly 70% of children seeking mental health or substance use care were unable to access it. Moreover, insured individuals are nearly 4 times more likely to go out-of-network for mental health care than for physical health care, often facing exorbitant costs or deferring care altogether.

This gap has only widened in recent years, with an 85% increase in out-of-network usage for mental health and substance use disorder benefits compared with physical health benefits. The new rule seeks to correct this disparity by reinforcing the core principle of MHPAEA: all Americans should have the same access to mental health and substance use benefits as they do to physical health benefits.

The Employee Benefits Security Administration (EBSA), US Department of Labor, has prioritized enforcing the federal parity law on mental health care since the administration's inception over 3 years ago, dedicating significant resources to investigations, identifying problems, and ensuring health plans comply.²

This past spring, Ali Khawar, principal deputy assistant secretary of the EBSA, discussed the efforts that supported the final rule with The American Journal of Managed Care^®. In addition to updating the 15-year-old rules already governing the law, the new rules were proposed and received public feedback. With the Biden-Harris administration making the final rule official, compliance expectations and enforcement should be more straightforward, Khawar explained.

"[The final rule] will kind of reframe what it means to be in compliance with this parity law, which we think will be a benefit to employers and health plans that are trying to do the right thing and offer robust mental health benefits or substance use benefits," he said. "It will be a benefit to the insurance community, because it will clarify really what our expectations are. And it will be a benefit to us because it will be easier for us to enforce it in a variety of circumstances."

Key Provisions of the Final Rule

The finalized rule implements several key measures aimed at enhancing access to mental health care¹:

1. Requiring Health Plans to Address Deficiencies: The rule mandates that health plans conduct thorough evaluations of their mental health care access, including assessing provider networks, payment rates for out-of-network providers, and the use of prior authorizations. If a plan is found to be failing to meet MHPAEA’s requirements, it must make necessary changes, such as expanding its network of mental health professionals or reducing bureaucratic hurdles.
2. Clarifying Permissible Health Plan Practices: Health plans will no longer be allowed to use restrictive prior authorizations or other medical management techniques that make it harder to access mental health and substance use benefits than medical benefits. They must also apply similar standards when setting out-of-network payment rates for mental health and substance use disorder providers as they do for medical providers.
3. Closing Loopholes: The rule addresses a loophole in the original MHPAEA that exempted non-federal governmental health plans, such as those for state and local government employees, from compliance. With the new rule, over 200 additional health plans will be required to comply with MHPAEA, extending critical protections to an additional 120,000 consumers.

Expanding the Mental Health Workforce and Reducing Costs

In addition to ensuring that health plans adhere to parity requirements, the Biden-Harris administration aims to lower health care costs for families by making it easier to access mental health and substance use care. By removing barriers that prevent timely and affordable access to care, the rule is expected to reduce out-of-pocket costs and promote early intervention.

Furthermore, the administration recognizes the importance of fairly compensating mental health and substance use care professionals. The new requirements will likely incentivize more individuals to join the mental health workforce, helping to address the shortage of providers and improve access to care across the country. The physician shortage is ongoing struggle across the country, and according to Khawar this is especially pronounced in mental health care.³

"One problem is that mental health careers for individuals who are in educational institutions are not necessarily as attractive as they could be," Khawar explained. "We don't have enough people in the pipeline going into those fields."

Additional Support for Medicaid Beneficiaries

HHS is also taking steps to ensure compliance with MHPAEA's protections for the millions of Medicaid beneficiaries enrolled in private Medicaid health plans.¹ New tools are being released to assist states in enforcing these critical protections, further expanding access to mental health care for some of the nation's most vulnerable populations.

A Bipartisan Priority

The new rule builds on over 15 years of bipartisan efforts to improve access to mental health care. The original MHPAEA legislation was enacted in 2008 with strong bipartisan support, and its strengthening in 2020 reinforced the commitment to ensuring parity between mental health and physical health care coverage. The Biden-Harris Administration's latest action reflects a continued dedication to addressing the nation's mental health crisis and expanding access to essential care for all Americans.

“President Biden and I are committed to ensuring that every person in our country has the mental health care they need to thrive. That is why we made the largest investment in youth mental health in history and are transforming how mental health is understood, perceived, and treated for all Americans," Harris said in the statement. "Today, we are building on this lifesaving and lifechanging work by announcing the finalization of a historic rule that will expand mental health care across our nation so more of our loved ones, neighbors, coworkers, and classmates receive the care they deserve.”

References

1. Fact sheet: Biden-⁠Harris administration lowers mental health care costs by improving access to mental health and substance use care. The White House. News release. September 9, 2024. Accessed September 10, 2024. https://www.whitehouse.gov/briefing-room/statements-releases/2024/09/09/fact-sheet-biden-harris-administration-lowers-mental-health-care-costs-by-improving-access-to-mental-health-and-substance-use-care/

2. Grossi G. Ali Khawar on Addressing the Mental Health Crisis Through Parity Law. AJMC. June 13, 2024. Accessed September 10, 2024. https://www.ajmc.com/view/ali-khawar-on-addressing-the-mental-health-crisis-through-parity-law

3. Grossi G. Ali Khawar: The Importance of Mental Health, AAPI Heritage Month. AJMC. May 28, 2024. Accessed September 10, 2024. https://www.ajmc.com/view/ali-khawar-the-importance-of-mental-health-aapi-heritage-month