The US Labor, Health and Human Services, and Treasury departments on Monday issued final rules meant to elevate mental health coverage to the same level as physical health coverage under private insurance plans. They will go into effect as early as Jan. 1.
“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 healthcare in America,” President Joe Biden stated in a fact sheet issued by the White House.
AHCA/NCAL and LeadingAge told the McKnight’s Business Daily that they are evaluating the rules but did not have a comment at this time.
“While we are still reviewing this rule in its entirety, we are supportive of efforts and policies that aim to ensure that mental health care is accessible to caregivers and their families through group and commercial insurers,” a spokesperson for AHCA said.
According to the White House, the final rules “will ensure mental healthcare coverage for 175 million Americans is on par with their physical healthcare coverage.”
The final rules are meant to strengthen consumer protections found in the 2008 Mental Health Parity and Addiction Equity Act and subsequent action taken in 2020 with the requirement that health plans evaluate their provider networks, how much they pay out-of-network providers, and how often they require – and deny – prior authorizations.
In essence, under the rules, health plans will not be able to apply stricter criteria to covering mental health treatment than they would to a physical illness. They will be required to set similar criteria for approving or denying a request, and they must use similar factors in setting out-of-network payment rates.
“The final rules are critical steps forward to making sure that people in need of services can get the care they need without jumping through hoops that they don’t face when trying to get medical or surgical care,” Assistant Secretary for Employee Benefits Security Lisa M. Gomez said. “Ending the stigma around mental health conditions and substance use disorders calls for a unified effort, and we appreciate the valuable feedback we received from stakeholders — plans, care providers and participants — in shaping these final rules.”
According to the Labor Department, most provisions of the final rules apply generally to group health plans and health insurance issuers that offer group health insurance coverage starting on the first day of the first plan year beginning on or after Jan. 1. Certain requirements that may take more time to implement will apply on the first day of the first plan year beginning on or after Jan. 1, 2026.
On Sept. 19, the Department of Labor will hold a compliance assistance webinar and will join the Treasury and HHS in providing guidance to employers on the rules. Interested employers can register here.
