Access to Mental Health, Substance Abuse Benefits Strengthened by Final Rule
Author: Robert S. Teachout, Brightmine Legal Editor
September 16, 2024
A new rule aims to ensure that group health plans and health insurance providers do not make it harder to access mental healthcare benefits or substance abuse treatment than to access other medical treatment. The final rule was issued jointly by the Departments of Labor (DOL), Health and Human Services (HHS) and Treasury.
Health plans that include mental health and substance use care coverage are required under the Mental Health Parity and Addiction Equity Act (MHPAEA) to provide benefits at the same level as medical healthcare. However, that often is not the case. According to research cited in the final rule, disparities in coverage between mental health and substance use disorder benefits and medical/surgical benefits have increased since the MHPAEA was passed in 2008.
The new rules add additional protections against nonquantitative treatment limitations (NQTLs) for mental health and substance use disorder benefits that are more restrictive than medical or surgical benefits. NQTLs are requirements that limit the scope or duration of benefits, such as prior authorization requirements, step therapy and standards for provider admission to participate in a network.
"Like medical care, mental health care is vital to the well-being of America's workers," said Acting Secretary of Labor Julie Su. "The final rules issued today make it easier for people living with mental health conditions and substance use disorders to get the life-saving care they often need."
The final rules also prohibit insurance plans from using biased or non-objective information and sources that might reduce and limit access to mental health and substance use disorder care when designing and applying NQTLs.
"Simply put, getting care for anxiety should be as easy as getting medical help for an injured shoulder, and getting medication to treat depression should be as simple as getting medication to treat high cholesterol," said Assistant Secretary for Employee Benefits Security, Lisa M. Gomez.
The DOL has posted a fact sheet about the final rule on its website. The final rule will take effect 60 days after it is published in the Federal Register, expected September 23.