US Government to Require Equal Coverage of Mental and Physical Health Services

A new rule set by the Biden administration will require health insurers to provide the same level of coverage for mental health care and addiction services as for other health conditions.

The Mental Health Parity and Addiction Equity Act (MHPAEA) already prohibits health insurers and corporate-backed group plans from imposing stricter limitations on mental health and substance use disorder benefits than on those for other health conditions.

However, administration officials say insurers have been skirting that law, making it more difficult for patients to find affordable care.

The new rule requires insurers to evaluate their current networks, the amount they pay out-of-network providers, and the frequency with which they require and deny prior authorization to assess their compliance with MHPAEA.

If found to fall short of legal requirements, insurers will also be required to take “reasonable action” to remedy that.

“Mental health care is health care. But for far too many Americans, critical care and treatments are out of reach,” President Joe Biden said on Sept. 9, announcing the new regulation.

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“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.”

Less than half of all U.S. adults with mental illness received treatment in 2020, while 70 percent of children with mental illness went untreated, according to studies cited by the administration.

The White House attributed those figures to insurance providers making it too difficult to access in-network care, leading patients to seek expensive out-of-network care or forgo treatment altogether.

White House domestic policy adviser Neera Tanden told reporters at a press briefing that, on average, patients enrolled in private health plans paid $1,500 annually in out-of-pocket costs for mental health treatment. That’s twice the amount paid by those with other health conditions.

“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,” said Lisa Gomez, assistant secretary at the U.S. Department of Labor, which regulates corporate-sponsored health plans under the Employment Retirement Income Security Act of 1974 (ERISA).

Melissa Bartlett, the committee’s senior vice president of health policy, warned at the time that the new regulation “could have unintentional yet catastrophic impacts on the progress that has already been made.”

Instead, Bartlett advocated for other “proven initiatives” to increase access to care, such as increasing telehealth services, incorporating mental health training for primary care providers, and incentivizing medical students to enter the behavioral health field.

As at December 2023, more than half of the U.S. population were living in an area with a shortage of mental health professionals, according to the Health Resources and Services Administration, with rural areas affected the most.

The health insurance industry is also likely to challenge the administration’s authority to implement the new rule, most of which is expected to take effect in 2026.

Reuters contributed to this report.