Biden announces rule to strengthen mental, physical health parity requirements

President Biden is announcing “new actions that would improve and strengthen mental health parity requirements and ensure that more than 150M Americans with private health insurance can better access mental health benefits under their insurance plan.” The proposed rule reinforces MHPAEA’s fundamental goal of ensuring that families have the same access to mental health and substance use benefits as they do physical health benefits. And it would make it easier to get in-network mental health care and eliminate barriers to access that keep people from getting the care they need, when they need it. Specifically, the proposed rule would require health plans to make changes when they are providing inadequate access to mental health care. The proposed rule would also make clear that health plans need to evaluate the outcomes of their coverage rules to make sure people have equivalent access between their mental health and medical benefits. This includes evaluating the health plan’s actual provider network, how much it pays out-of-network providers, and how often prior authorization is required and the rate at which prior authorization requests are denied. Additionally, the proposed rule will provide specific examples that make clear that health plans cannot use more restrictive prior authorization, other medical management techniques, or narrower networks that make it harder for people to access mental health and substance use disorder benefits than their medical benefits. Under the proposed rule, 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. When MHPAEA was first enacted, it did not require non-federal governmental health plans, like those offered to state and local government employees, to comply with its requirements. The proposed rule would close that loophole and codify Congressional changes made to MHPAEA by requiring more than 200 additional health plans to comply with MHPAEA, providing critical protections to 90,000 consumers. In addition to announcing the proposed rule, the President also announced the Administration’s intention to issue a request for information on how it can best work with states to ensure compliance with MHPAEA’s critical protections for the millions of Medicaid beneficiaries enrolled in private Medicaid health plans. Publicly traded companies in the telehealth space include Teladoc (TDOC), Amwell (AMWL), Amdocs (DOX), and 1Life Healthcare (ONEM).