Newly Released Proposed Federal Mental Health Rule Seeks To ‘Make Parity A Reality’

The Biden Administration introduced a new proposed rule focused on strengthening mental health parity regulations.

Specifically, the proposal sets out to clarify health plan’s requirements for nonquantitative treatment limitations (NQTL) comparative analyses and network composition.

NQTL are health plan practices that are not associated with specific numbers but still have an influence on whether and how members can access treatment. Prior authorizations and other medical management techniques are examples of NQTLs.


This proposal is part of the Biden administration’s larger effort “to make parity a reality.”

“Throughout the U.S., people in need of help continue to encounter illegal restrictions on their mental health and substance use disorder benefits,” Assistant Secretary for Employee Benefits Security Lisa Gomez said in a news release, “And struggle to find mental health and substance use treatment providers that participate in their plan’s networks.”

The U.S. Department of Labor sent the proposed rule to the White House’s Office of Management and Budget (OMB) — a last-stop review before publication — on July 10. The text of the proposed mental health parity rule was not available until Tuesday.


The proposed rules would incorporate provisions from several laws passed by Congress as well as the experience of several federal agencies since the last major overhaul of mental health parity rules in 2014.

If finalized, it would also clarify and strengthen existing regulations called for in the Mental Health Parity and Addiction Equity Act (MHPAEA), a law passed in 2008 that sought to prevent health plans from treating behavioral health benefits differently than physical health benefits. The rule also addresses congressional directives that were enacted in recent legislative efforts.

Here are other specifics that the newly proposed rule would do if it became effective:

— Make it clear that the MHPAEA requires that plan members have equal access to behavioral health services

— Require health plans to study, assess and act on the impact of NQTLs on accessing mental health and substance use disorder (SUD) benefits and physical health benefits

— Establish content requirements for NQTL comparative analyses

— Set forth how health plans are to make comparative analyses available to the U.S Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury, as well as state authorities and plan members

— Update examples of the application of the parity rules for NQTLs

— Trigger the sunset provisions of self-funded, non-Federal governmental plan’s exemption from the MHPAEA

Behavioral health executives and advocates have long accused health plans of shortchanging members and providers on behavioral health benefits, both in terms of the actual reimbursements paid and the bureaucratic hurdles health plans put in place to get care in the first place. Early mental health parity efforts on the part of Congress go as far back as 1996

Health plans’ treatment of behavioral health benefits has led to high-profile court battles. These include plan members suing payors such as United Behavioral Health and Aetna.

The release of the proposed parity rule kicks off a 60-day public comment period. The U.S. Department of the Treasury, DOL and HHS also issued a technical release that requests feedback on the proposed new data requirements used in assessing the adequacy of health plans’ provider networks.

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