‘It’s A Huge Deal’: Behavioral Health Stakeholders Praise New Mental Health Parity Rule

The public comment period hasn’t begun for the Biden administration’s recently published proposed mental health parity rule. But that hasn’t stopped a flood of commentary on the rule from entering the public sphere already.

On July 25, the administration released a proposed rule that firms up mental health parity in terms of health plan’s compliance with non-quantitative treatment limitations (NQTL) comparative analyses and network composition.

Once the proposed rule is published in the Federal Register, the administration will conduct a 60-day public comment period. Those comments may or may not have formal influence over the final rule once published.

Advocates for the health insurance industry have already voiced their concerns over the present status of mental health parity rules in the U.S.

For example, the payer-focused HR Policy Association argued that federal NQTL comparative analyses regulations were unclear and called on the Biden administration to release comprehensive guidance.

On a teleconference with federal stakeholders, the organization referenced a 2022 joint report from U.S. Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury that found that no health plan complied with the NQTL reporting requirements.

“When not one employer plan has a sufficient comparative analysis, it is not because none of them want to comply,” HR Policy Association said in a public written comment. “It is because they do not know how to comply, which makes comprehensive compliance guidance critical.”

Members of the public can comment on and meet with members of the executive branch about proposed rules that are under review by the OMB but have not yet been released under Executive Order 12866.

Meanwhile, health care provider organizations and advocates broadly applaud the rule and, in some cases, call for the administration and Congress to go further.

In a speech, Pres. Joe Biden said addressing parity is vital to addressing the wider issue of mental health in the U.S. by “requiring health insurance plans to identify the gaps in the mental health care that they provide.”

“The actions we’re announcing today represent a real step forward to help millions of people get [the] mental health care they need and their insurance should be provided,” Biden said at a press briefing Tuesday. “But there’s still so much more to do. … Today, we took a big step on coverage. Now we need to keep expanding care — for example, by increasing access to telemedicine; expanding our mental health workforce.”

Addressing behavioral health issues is part of Biden’s Unity Agenda. In 2022, the administration and Congress passed several reforms that have a bearing on the industry from a regulatory and funding perspective.

The proposed mental health parity rule largely addresses and strengthens existing rules.

Behavioral Health Business assembled a sampling of several organizations’ comments on the matter.  

The HR Policy Association

Employers have innovated and invested in significant new behavioral health benefits during the COVID pandemic. Addressing the current mental health care crisis and achieving mental health parity compliance will require significant efforts in partnership between employers, providers, government, patient groups and other stakeholders.

To achieve mental health parity compliance, OMB should:

— Require DOL to publish the comprehensive guidance required by the CAA and additional de-identified examples of comparative parity analyses that are compliant under a final determination letter; and

— Urge DOL to consider adding a “safe harbor” or model parity analysis/template that creates a less burdensome way to achieve good faith compliance with the law.

AHIP

[We] want to reiterate and make clear: mental health is good health, period.  We agree that everyone deserves access to mental health care, and that access should be on par with physical health.

Access to mental health has been, and continues to be, challenging primarily because of a shortage and lack of clinicians, which is why for years, health insurance providers have implemented programs and strategies to expand networks and increase access. Those approaches include creating new coverage pathways with expanded access through telehealth and new technologies, and integrating mental and physical health care.  It also involves working with primary care doctors on identifying mental health needs, providing pathways to care, and incorporating quality and value.

The significant increase in use of mental health care since passage of the federal parity law provides strong evidence that [the Mental Health Parity and Addiction Equity Act (MHPAEA)] is working and providing patients with access to the quality, affordable health care they need. Even before the pandemic’s massive impact on mental health needs, according to a FAIR Health study, the number of private insurance claims for behavioral health diagnoses increased 108% from 2007-2017, indicating that more people are getting treatment in the decade since MHPAEA was enacted.

Health insurance providers have a consistent, clear commitment to improving access to mental health, as well as solutions that will work for Americans. We encourage the Administration to work with health insurance providers, clinicians, patients and other stakeholders alike to continue to improve access.

The Association for Behavioral Health and Wellness (ABHW)

ABHW fully supports the concept of mental health parity and was instrumental in the passage of MHPAEA. ABHW members have worked tirelessly over the past 15 years to implement parity for mental health and substance use disorder services and are dedicated to complying with the law and working to increase access and quality for consumers.

“We appreciate that the 2023 Mental Health Parity and Addiction Equity Act (MHPAEA) Report to Congress was released, and the examples of non-compliance will be helpful to health plans as they work to continue to comply with MHPAEA,” said Pamela Greenberg, President and CEO of ABHW. “However, the Report demonstrates the need for the Tri-Departments to provide sample non-quantitative treatment limitations (NQTLs) analyses to help further MHPAEA compliance.”

In terms of the proposed rule, ABHW is concerned that it redefines the standard of analysis for NQTLs by creating a quantitative test. However, ABHW advocated for and is pleased to see that the proposed rule recognizes the value of the concept of safe harbors for health plans that meet specific standards.

“ABHW remains committed to improving access to behavioral health treatments and services and is eager to continue working with the Tri-Departments and our members to ensure everyone can receive the care they need when they need it,” said Greenberg.

American Medical Association (AMA) President Dr. Jesse Ehrenfeld

The AMA strongly supports the Biden administration’s commitment to addressing insurers’ continued failures to comply with the MHPAEA.

For more than 15 years, the combined lack of enforcement and compliance with MHPAEA has been a significant factor driving the nation’s mental health crisis and substance use disorder epidemic, which have both been exacerbated by the pandemic. Insurers’ egregious violations of MHPAEA contribute to growing inequities in mental health and substance use disorder care, which often falls disproportionately to historically minoritized communities.

When behavioral health treatment is delayed or denied, the results can be tragic and for far too long, insurers have created improper barriers to care through unnecessary administrative burdens including prior authorization, inadequate networks, lack of benefits and other denials or delays in necessary care. The AMA continues to urge the administration to take action to remove barriers to evidence-based mental health and substance use disorder care in all health insurance programs.

We urge the Biden Administration to provide the Labor Department with the necessary resources to make oversight and enforcement of MHPAEA a top priority. We hope the Labor Department, as well as states, will increase efforts to regularly review plans to ensure they are in compliance with MHPAEA—and hold insurers accountable if they are not.

American Hospital Association (AHA) Group Vice President of Public Policy Molly Smith

The AHA is pleased that the Administration is proposing decisive action to limit barriers to access vital mental health and substance use disorder services.

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.

The Kennedy Forum CEO and President Rebecca Bagley

Better coverage for mental health and substance use care services is urgently needed to reduce the tremendous burden these illnesses have on individuals, families, communities, and our entire country. The proposed rules provide significantly greater clarity on what health plans must do to comply with the Federal Parity Act, including ensuring equitable reimbursement and provider networks. Once finalized, the revised parity rules will help Americans get the coverage they need and employers prepare for the next generation of workplace mental health.”

The National Association for Behavioral Healthcare President and CEO Shawn Coughlin

Today’s rules show the Biden administration’s continued effort to implement the landmark parity law. We’re hopeful these changes will do much to eliminate the illegal restrictions and barriers to behavioral healthcare that exist today, nearly 15 years after the law passed.

National Council for Mental Wellbeing President and CEO Chuck Ingoglia

Too often, arbitrary barriers prevent people from getting the mental health and substance use treatment and care they need. Not knowing where to go or not knowing if it will result in a significant out-of-pocket cost is enough to stop someone from accessing lifesaving care.

CEO Alliance for Mental Health

The CEO Alliance for Mental Health (CEO Alliance) … applauds President Biden for continuing to prioritize mental health and substance use parity with today’s release of proposed rules to improve health plan compliance with the MHPAEA. … Unfortunately, 15 years after its enactment, the promise of MHPAEA has not been fully realized, and far too many individuals still do not receive the appropriate level of care for their conditions.

The primary goal for each organization in the CEO Alliance is to help people realize their full potential and save lives. The Biden Administration’s new proposal would significantly strengthen our nation’s parity enforcement and ensure that people with mental health and substance use conditions do not face arbitrary barriers to receiving the care they need and deserve. … The member organizations of the Alliance look forward to commenting on the proposed rule to strengthen it further and responding to requests for information to ensure enforcement of the provisions that require access to affordable care.

National Association of Addiction Treatment Providers (NAATP)

NAATP has been at the forefront of advocating enforcement of this bi-partisan law. We commend the Administration for their willingness to enforce Parity which will help save millions of lives. We also congratulate our coalition partners who have also worked diligently to achieve full enforcement, particularly the Kennedy Forum. … NAATP has advocated for the ability to fine insurers who continually ignore the law with few consequences.

American Psychiatric Association

For far too long and despite efforts from the federal and state governments, many insurers have treated mental health as an afterthought to physical health, leaving patients and families dealing with mental health and addiction issues scrambling to find affordable care, or going without. Today’s actions from the White House to bolster and strengthen enforcement of the nearly 15-year-old mental health parity law are important steps toward ensuring more Americans who need these services can access them.

American Addiction Centers CEO Tom Britton

All progress is progress. One thing that is unique that I read in this rule is this. The federal government is aware of the network adequacy issue. This is targeting that issue. That’s newer to me. And it’s a huge deal. A lot of patients can’t get care just because there’s not somewhere to go.