Health insurers will be required to cover mental health care and addiction services the same as any other condition under a highly anticipated final rule being released Monday by the Biden administration.
The move is part of the administration’s ongoing battle with health insurers, who officials say are skirting a 2008 law requiring plans that cover mental health and substance use care benefits do so at the same level as physical health care benefits.
The health insurance industry is likely to challenge the rule, saying the administration did not have the authority to issue it to begin with.
It argued the proposed requirements were unworkable and an unfunded government mandate that would cause employers to stop covering behavioral health services.
Essentially, any financial requirements and treatment limitations like copays, coinsurance and visit limits imposed on mental health and substance use disorder benefits can't be more restrictive than the ones that apply to all medical and surgical benefits.
“Mental health and substance use disorder benefits should not come with any special roadblocks,” Lisa Gomez, the assistant secretary for employee benefits security at the Department of Labor, told reporters at a press conference.
“It’s simple: It shouldn’t be harder for you to get care when you feel depressed than getting care when you have back pain. It shouldn't be harder for you to find a provider that can treat your eating disorder than it is to find a provider who can treat your ulcer.”
The final regulation comes as the nation is facing a worsening mental health and substance use crisis. Most people with substance abuse or mental health disorders don't get treatment, studies have shown. Even people with insurance can face prohibitive costs, as many providers are out of network.
The rule comes after a proposal last summer from the departments of Health and Human Services, Labor and Treasury.
Officials said the final rule strengthens the proposal while also giving more flexibility to health plans.
The rule will require health plans to make changes when they are providing inadequate access to mental health and substance use care. The administration said health plans will be compelled to conduct, and act on, comparative analyses that were already required under the law.
Plans will need to evaluate how much they pay out-of-network providers, and how often they require — and deny — prior authorizations.
The rule will also close a loophole from when the parity law was first enacted, by requiring compliance from more than 200 additional nonfederal governmental health plans, like those offered to state and local government employees.
“This final rule will stop the industry evasion that has led millions of people to pay for care even when they have insurance,” said Neera Tanden, head of President Biden’s Domestic Policy Council.
But officials did not describe any new enforcement mechanisms, saying only that plans would comply as a means of staying competitive.
In separate statements, Biden and Vice President Harris cast the new rule is part of the administration’s effort to expand mental health coverage.
“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 health care in America,” Biden said.
“President Biden and I are committed to ensuring that every person in our country has the mental health care they need to thrive,” Harris said, touting a “historic rule that will expand mental health care across our nation so more of our loved ones, neighbors, coworkers, and classmates receive the care they deserve.”
While mental health coverage parity is often bipartisan, at least one top Republican objected.
Rep. Virginia Foxx (R-N.C.), chair of the House Education and the Workforce Committee, echoed the insurance industry’s argument that the rules are an overreach.
“For over a year, we’ve been telling the Biden-Harris administration that these rules will not work. They are too vague and burdensome; they overregulate instead of allowing health plans to build robust networks; and they will increase premiums for employees already facing high health care costs,” Foxx said in a statement. “These rules do nothing to improve mental health care access and instead put paperwork over patients.”
