What’s the news: The Biden administration recently issued new rules to provide additional clarity and help prevent health insurance companies from continuing to routinely violate the Mental Health Parity and Addiction Equity Act. The law, which was enacted in 2008, requires health insurers to treat benefits for mental health and substance-use disorders similarly to how they treat medical and surgical benefits.
The 2008 law requires, in part, that health insurers not impose additional or more restrictive rules on coverage for mental health or substance-use disorder treatments in similar categories—for example, by requiring prior authorizations or copays for mental health or substance abuse treatments where the requirements do not exist for medical or surgical conditions.
The new rules clarify and emphasize the existing provisions of the law, while also requiring the collection of data and analysis to ensure compliance. They also prohibit the use of biased methods that make it harder for patients to access mental health or substance-use disorder treatment and enforce the ending of the opt-out phase of the law.
The AMA supported the latest rules when they were proposed in 2023, saying at the time that they represented a much-needed attempt to combat “insurers’ continued failures to comply” with the federal law. In a statement after the most recent announcement, AMA President Bruce A. Scott, MD, lauded efforts to enforce the parity law.
Dr. Scott commended the Biden administration for its commitment to ensuring that the MHPAEA “has the teeth to protect patients from health insurance company actions that unfairly and too-often discriminatorily restrict access to mental health and substance use disorder care.
“Health plans have violated MHPAEA for more than 15 years, and this final rule is a step in the right direction to protect patients and hold health plans accountable for those failures,” Dr. Scott said, adding that the AMA is still examining the full impact of the rules. A detailed and comprehensive AMA analysis of the 500-page rule is forthcoming.
“While the AMA continues to evaluate the final rule, the AMA strongly supports multiple provisions that will help increase transparency, oversight and enforcement of MHPAEA in areas such as prior authorization and network adequacy,” he said.
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Why it matters: A 2022 report to Congress by the same departments that issued the most recent rules showed continued disregard for the provisions of the 2008 law, saying that, for example, one health insurer covered nutrition counseling for diabetes but not for anorexia nervosa, bulimia nervosa or binge-eating disorder.
“The report’s findings clearly indicate that health plans and insurance companies are falling short of providing parity in mental health and substance-use disorder benefits, at a time when those benefits are needed like never before,” Labor Secretary Marty Walsh said at the time.
The AMA believes, and evidence shows, that the lack of appropriate access to mental health treatment contributes to dual behavioral health and overdose death crises in the United States.
In support of the rule, the Biden administration pointed to concerning data:
- In 2020, less than half of all adults with mental illness received treatment. Meanwhile, nearly 70% of children who seek care for mental health or substance use cannot get it.
- One study shows that insured people are nearly four times as likely to go out-of-network and pay higher fees for mental health care than for physical health care.
- In recent years, the gap between use of out-of-network care for mental health and substance use-disorder benefits versus physical health benefits rose 85%.
Learn more: In a Leadership Viewpoints column, former AMA President Jack Resneck Jr. explained in detail why the lack of access to evidence-based mental health care poses a grave threat to public health.
With more people reporting worsening mental health in recent years, it’s imperative that patients and physicians know about the 988 Suicide & Crisis Lifeline, formerly known as the National Suicide Prevention Lifeline. The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources, and best practices for professionals in the U.S.
Explore further with the AMA “Suicide Prevention How-To Guide” (PDF).
