Biden Administration Finalizes Mental Health Parity Rule

The Centers for Medicare and Medicaid Services (CMS) has finalized a landmark rule that will require insurers to provide parity between their coverage for mental health and medical or surgical benefits. The rule also aims to expand access to mental and behavioral health services.

The rule fulfills a proposal from last summer and will require health plans to adjust their coverage practices if they are failing to adequately provide mental and substance use disorder health coverage. According to the Hill, plans will need to codify how much they pay out-of-network providers for behavioral health services and document their use of prior authorization. It will also close a loophole in the 2008 mental health parity law by requiring compliance from nonfederal governmental health plans including those offered to state and local government employees.

Stakeholders were very involved in the finalization of the rule, but a coalition of insurers and large employers argued that the rule could result in such groups dropping mental health coverage instead of trying to comply with the law, Inside Health Policy reports. But the White House doubled down on the rule, stressing that it would strengthen consumer protections and correcting rules made in the spirit of the Mental Health and Addiction Equity Act.

The rule adds additional protections against “non-quantitative treatment limitations,” which limit the scope or duration of benefits, like step therapy and standards for provider participation, the CMS website explains. From Assistant Secretary for Employee Benefits Security, Lisa M. Gomez:

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.