On Tuesday, the Biden administration released a proposal that would require health insurers to cover mental health and addiction care as comprehensively as physical health conditions.
If the proposal is implemented, it could help end decades of back-and-forth between insurance companies and government regulators. Although insurers have been required by law to cover mental health and addiction treatment since the 1990s, many have never fully complied, forcing patients to jump through bureaucratic hurdles or even pay out-of-pocket for care.
The new rule would require insurers to evaluate their own networks to determine not only if they provide adequate mental health and addiction coverage but also if patients can actually access it.
During a press call, Neera Tanden, President Biden’s domestic policy advisor, stated, “This rule will ensure that we have true parity.” “It will help ensure that we finally fulfill the promise of parity in mental health coverage, as mandated by the law, to ensure that mental health is covered in the same manner as physical health.”
When insurers disobey parity laws, the federal government has had limited recourse in the past. In a press conference announcing the new rule, Biden administration officials did not specify any new punishments for non-compliant insurers but stated that the plans would continue to be subject to regulation and penalties for breaking the law.
The new proposal, which will soon be published as a joint proposed rule by the Treasury, Labor, and Health and Human Services departments, comes at a time when cost concerns force innumerable Americans to forego essential mental health or addiction care.
White House aides cited a study indicating that individuals with health insurance are more than twice as likely to seek out-of-network treatment for mental health conditions than for physical health conditions.
The new rule would also target more discreet health insurer practices, such as offering lower rates to out-of-network mental health providers or imposing higher prior authorization requirements for mental health care than for most physical health services and procedures.
In addition to requiring greater accountability from insurers, the rule closes a loophole that presently permits state and local governments to opt out of mental health parity requirements.
According to Biden administration officials, the change could result in more comprehensive coverage for roughly 90,000 government employees insured by these plans.
This is not the first time that the federal government has attempted to tighten down on insurers accused of providing inadequate mental health and addiction coverage.
In 1996, Congress enacted the Mental Health Parity Act. In 2008 and again in 2020, lawmakers amended the law in part to provide federal regulators with more enforcement tools.
The administration presented the new regulations as a continuation of other mental health initiatives, such as the nearly $1 billion invested in the 988 suicide and crisis lifeline.
“Today’s actions will help more than 150 million Americans with private health insurance better access mental health benefits through their own plan,” said Tanden. With more stable reimbursement from insurers, we anticipate a substantial increase in access to necessary care. Help is on the way for the many families who are paying out of pocket for the care their loved ones require.”