"It’s a 'be careful what you wish for' situation for employers and health plans," Sarah Raaii, a partner at the law firm McDermott Will & Emery, said in a statement. "They have been frustrated by the lack of agency guidance on exactly how to apply the mental health parity rules, so these final rules might shed some light on that, while creating additional obligations for employers and health plans."
When HHS, Labor and Treasury published the proposed rule last year, the departments asserted stricter regulation is need because of widespread noncompliance with parity laws including the Mental Health Parity and Addiction Equity Act of 1996, the Mental Health Parity and Addiction Equity Act of 2008, the Affordable Care Act of 2010 and the Consolidated Appropriations Act of 2021 amid high demand for mental health services.
“The final rules are critical steps forward to making sure that people in need of services can get the care they need without jumping through hoops that they don’t face when trying to get medical or surgical care,” Lisa Gomez, assistant secretary of Labor for employee benefits security, said in a Centers for Medicare and Medicaid Services news release.
The regulation generally applies to group health plans beginning Jan. 1. Some provisions, such as those implementing the requirements for individual market plans, take effect Jan. 1, 2026.
In addition, the rule requests comments on draft CMS guidelines on how mental health parity applies to Medicaid managed care plans, Medicaid alternative benefit plans and Children's Health Insurance Program plans.
The health insurance trade group AHIP, the Blue Cross Blue Shield Association and the ERISA Industry Committee, which represents employers with benefit plans governed under the Employee Retirement Income Security Act of 1974, blasted the rule in a joint news release.
“The final Mental Health Parity and Addiction Equity Act (MHPAEA) rule will have severe unintended consequences that will raise costs and jeopardize patients’ access to safe, effective and medically necessary mental health support," the organizations said. "Instead of expanding the workforce or meaningfully improving access to mental health support, the final rule will complicate compliance so much that it will be impossible to operationalize, resulting in worse patient outcomes.”
The regulation could face legal challenges, said Melissa Bartlett, senior vice president of health policy for the ERISA Industry Committee. "We will consider all possibilities to prevent further harm to employers offering behavioral health benefits, and the employees and families who count on them — up to and including litigation," she wrote in an email.
Health insurance companies will struggle to find enough behavioral health providers to meet the rule's standards, a Blue Cross Blue Shield Association spokesperson wrote in an email. "Building a more robust mental health workforce requires a robust effort. We need to expand the use of non-clinical personnel, expand access to telehealth services and increase the mental health workforce pipeline," the spokesperson wrote.
The American Psychological Association praised the policies regarding provider networks and rejected the insurance industry argument that there simply aren't enough mental health providers to make compliance possible. "There is a large pool of psychologists ready to work with insurance companies if treated fairly,” Jared Skillings, chief of professional practice, said in a statement.
"This is a big step forward to hold insurance plans accountable by ensuring the law’s intent is fulfilled and that more individuals will be able to access the mental health and substance use treatment they need," American Psychiatric Association CEO and Medical Director Dr. Marketa Wills said in a news release.
The American Medical Association "commends" the Biden administration for issuing the regulation, President Dr. Bruce Scott said in a news release.
"The AMA strongly supports multiple provisions that will help increase transparency, oversight and enforcement of MHPAEA in areas such as prior authorization and network adequacy," Scott said "Health plans have violated MHPAEA for more than 15 years, and this final rule is a step in the right direction to protect patients and hold health plans accountable for those failures."
Michael McAuliff contributed to this story.
