The Biden administration on Tuesday announced a proposal meant to force health insurers to cover mental health and addiction care as comprehensively as they cover treatment for physical health conditions.
If the plan is enacted, it could help end decades of whack-a-mole between government regulators and insurance companies. While insurers have been legally required to cover mental health and addiction treatment since the 1990s, many have never truly complied, forcing patients to jump through bureaucratic hoops, or even pay out-of-pocket, to obtain care.
The new rule would force insurers to evaluate their own networks to measure not just whether they’re offering adequate mental health and addiction coverage, but also whether patients are truly accessing it.
“This rule will ensure that we have true parity,” Neera Tanden, President Biden’s domestic policy advisor, said during a press call. “It will help ensure we finally fulfill the promise of mental health parity required under the law, to ensure that mental health is covered just like physical health.”
Historically, the federal government has had little recourse when insurers ignore parity laws. In a press call announcing the new rule, Biden administration officials did not list any specific new punishments for out-of-compliance insurers, but said the plans would continue to be regulated and subjected to fines for violating the law.
The new proposal, which will soon be published as a joint proposed rule from the Treasury, Labor, and Health and Human Services departments, comes as cost concerns force countless Americans to go without much-needed mental health or addiction care.
One study cited by White House aides showed people with health insurance are more than twice as likely to seek out-of-network care for mental health conditions than for physical health conditions.
The new rule would attempt to crack down on some health insurers’ more subtle tactics, too, like offering lower rates to out-of-network mental health providers or imposing prior authorization requirements for mental health care at a higher rate than for most physical health services or procedures.
Beyond seeking more accountability from insurers, the rule also closes a loophole that currently allows health insurance plans offered by state or local governments to opt out of mental health parity requirements. The change could lead to more comprehensive coverage for roughly 90,000 government employees insured by those plans, according to Biden administration officials.
The Biden administration’s latest effort is hardly the first time the federal government has attempted to crack down on insurers accused of skimping on mental health and addiction coverage.
Congress first passed the Mental Health Parity Act in 1996. Lawmakers amended the law in 2008, and again in 2020, partly for the purpose of giving federal regulators more tools to enforce compliance.
The administration cast the new rules as building on other mental health initiatives, including the investment of nearly $1 billion into the 988 suicide and crisis lifeline.
“Today’s actions will help the more than 150 million Americans with private health insurance better access mental health benefits through their own plan,” Tanden said. “With more stable reimbursement from insurers, we expect much more access to needed care. For the many families out there who are paying out-of-pocket … for the care their loved ones need: Help is on the way.”
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