A mental health “parity law” is one requiring health plans to provide comparable coverage for mental health as it does for physical ailments. The nation’s first mental health parity law, the Mental Health Parity Act of 1996 (MHPA), provided that large group health plans can’t impose annual or lifetime dollar limits on mental health benefits that are less favorable than equivalent limits imposed on medical/surgical benefits.
In 2006, New York passed Timothy’s Law, the first state mental health parity law. Timothy’s Law, unlike the MHPA, provides parity for substance use disorders. Timothy’s Law requires group health plans to provide comparable coverage for mental health and substance use disorders (MH/SUD) as they do for physical ailments.
In 2008, Congress passed the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). This federal law, the federal answer to Timothy’s Law, prohibits group health plans and health insurance issuers providing mental health or substance use disorder benefits from imposing less favorable benefit limitations (e.g., out of pocket maximums, lifetime deductibles) on those benefits than on medical/surgical benefits.
In September of 2024, the U.S. Departments of Health and Human Services (HHS), Labor, and the Treasury collectively released a new final rule to further implement the MHPAEA. The new final rule further protects individuals in group health plans or group or individual health insurance coverage who seek treatment for mental health or substance use disorder treatment. This new final rule protects these individuals by reducing burdens on access to benefits for mental health or substance use treatment. Details of the 2024 mental health and substance use care final rule are provided below.
Why Was the 2024 Mental Health and Substance Use Care Final Rule Issued?
America is experiencing a mental health and substance use disorder crisis. While COVID-19 worsened this crisis, the crisis continues to worsen post-pandemic. From August 19, 2020, to February 1, 2021, the percentage of adults exhibiting symptoms of anxiety or depressive disorders rose from 36.4 percent to 41.5 percent. In 2022, an estimated 15.4 million adults aged 18 and older had a serious mental illness, while nearly one in four adults were living with any mental illness. In 2022, although roughly 55 million people 12 and older were classified as needing treatment for substance use, only about 24 percent of those people received any treatment, according to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health (NSDUH).
What Are the Highlights of the 2024 Mental Health and Substance Use Care Final Rule?
The Mental Health and Substance Use Care final rule provides the following protections:
1. The mental health and substance use care final rule protects health plan participants, beneficiaries, and enrollees from facing greater restrictions on access to mental health and substance use disorder benefits, as compared to medical and surgical benefits.
Examples: If a health plan does not put a limit on the number of visits for in-network outpatient physical or medical care, it may not limit the number of visits for in-network outpatient mental health and substance use disorder care. Other common limits placed on mental health and substance use disorder benefits and services subject to parity include:
a. Limits on copayments (plans must apply comparable copays for mental health and substance use disorder care and physical healthcare); and
b. Limits on prior authorization (prior authorization requirements for mental health and substance use disorder services must be comparable to or less restrictive than those for physical health services).
2. The mental health and substance use care final rule requires health plans to make changes when they are providing inadequate access to mental health and substance use care. Under the final rule, plans must evaluate their provider networks, how much they pay out-of-network providers, and how often they require – and deny – prior authorizations. The outcomes of these evaluations will show plans where they are failing to meet MHPAEA requirements, and where they will need to make changes to come into compliance.
Example of Required Changes: Required changes may include plan measures such as adding more mental health and substance use professionals to a plan’s networks or a plan’s reducing bureaucratic red tape for providers to deliver mental health and substance use care.
3. The mental health and substance use care final rule clarifies what health plans can and cannot do to meet parity obligations:
a. Health plans cannot use narrower networks to make it harder for people to access mental health and substance use disorder benefits than their medical benefits.
b. Health plans must use similar factors in setting out-of-network payment rates for mental health and substance use disorder providers as they do for medical providers.
c. State and local government health plans must now comply with MHPAEA requirements (when the MHPAEA was enacted, the law did not cover non-federal governmental health plans).
The mental health and substance use care final rule can be accessed by clicking here.
How Can Compliancy Group’s Solution Help Mental Health Practitioners?
Compliancy Group’s proprietary healthcare compliance tracking solution, The Guard, can be used by behavioral health professionals to monitor their healthcare compliance, including HIPAA and OSHA compliance. Behavioral health providers subject to HIPAA can use The Guard to monitor their compliance in areas that include (1) appropriate use and disclosure of PHI, and (2) when psychotherapy notes may be disclosed. The Guard also contains a series of QuickStart guides that behavioral health providers may use as a framework for developing HIPAA and OSHA compliance initiatives.
