By the Policy Center for Maternal Mental Health Policy Team

On July 25th, 2023, the Departments of Labor, Health and Human Services and the Treasury announced proposed rules to strengthen the Mental Health Parity and Addiction Equity Act. We have been honored to be a part of shaping these rules with the Department of Labor and The Kennedy Forum over the past several years and will be submitting a comment letter with our feedback on the rules soon.

Our work shaping and reporting on national mental health policy is made possible through a 2020-2023 capacity grant from the Perigee Fund.

The Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted in 2008 and aims to ensure people seeking mental health and substance use disorder (SUD) care do not experience greater barriers to care than those seeking medical/surgical care. This federal law was enacted to prevent group health plans and issuers from having less favorable benefits, such as higher copayments and prior authorizations, for mental health care than for medical/surgical care. Although this law has been in place since 2008, people seeking mental health and SUD care continue to face greater barriers to accessing care than when they are seeking medical or surgical care.

The proposed rule would require insurers and health plans to:

Analyze their approval and denial rates of doctors’ requests to authorize mental illness treatment, compared to medical/surgical care
Analyze their provider networks and compare their reimbursement rates for out-of-network providers for mental health and SUD care to medical/surgical care
Ensure that they are in compliance with the guidelines on limiting requirements for doctors to obtain insurers’ prior authorization to prescribe medicine/procedures

The rule notes that insurers/plans can be fined for not offering comparable mental health/SUD benefits to medical/surgical benefits. The Administration hopes that requiring health plans to pay mental health providers more, will help build networks of in-network mental health providers.

Maternal Mental Health

The Proposed Rule would also have an impact on Maternal Mental Health, as explained by the Department of Labor (DOL), “By increasing access to services, these proposed rules would lead to more people receiving treatment, reducing the burden on family members and other support systems. This includes untreated maternal mental health conditions (MMHCs) which can lead to a reduced ability to work, increased risk of suicide, increased use of public services such as Medicaid, and worse maternal and child health.”

Additionally, the DOL cites the economic impact of untreated MMHDs:

A 2022 study of the cost of MMHC to Texas women and their children projected costs for the 2019 birth cohort from the time of conception through five years postpartum to total $2.2 billion.^[246] Untreated MMHCs include untreated perinatal mood and anxiety disorders (PMADs), which have been found to account for approximately $48 million in societal costs in Vermont for the average annual birth cohort from conception through five years postpartum, including $12.5 million in productivity loss and $9.4 million in non-obstetric health expenditures.^[247] The cost in missed productivity due to workers' fair or poor mental health was estimated as $47.6 billion annually in 2022.^[248] A 2022 study found that households with a family member diagnosed with a mental health disorder had lower health status scores compared to households without a mental illness diagnosis, suggesting evidence of family spillover effects on mental illness.^[249]

In addition to issuing the proposed rule, the DOL issued the second MHPAEA Comparative Analysis Report to Congress and a joint fact sheet with CMS on the MHPAEA enforcement. These documents provide the comparative analyses that health plans must conduct for compliance purposes and an outline of the department’s enforcement efforts. The report also highlights the plans/insurers that have failed to comply with the MHPAEA.

The DOL also issued a request for public comment on the Proposed Relevant Data Requirements for Non Quantitative Treatment Limitations (NQTLs) Related to Network Composition and Enforcement Safe Harbor for Group Health Plans and Insurance Issuers Subject to the Mental Health Parity and Addiction Equity Act, which the Policy Center for Maternal Mental Health plans to submit comments in the coming weeks.

Finally, the DOL wants providers and patients to know that they can file a complaint about their insurance/plan and mental health care, regardless of what type of coverage or benefit plan they have. Anyone can file a mental health complaint with the DOL, here.

The Assistant Secretary for Employee Benefits Security, Department of Labor, Lisa M. Gomez shares:

“Anyone who has ever lived with a mental health condition or substance use disorder — or who has a friend or family member who has — knows how hard getting through the day can be at times and should not have to be worried about facing obstacles to getting treatment. Yet, throughout the U.S., people in need of help continue to encounter illegal restrictions on their mental health and substance use disorder benefits and struggle to find mental health and substance use treatment providers that participate in their plan’s networks. Today’s proposed rulemaking is an important step for the departments and stakeholders to work together to make parity a reality.”-

Read more about the proposed rule in the White House Fact Sheet. If you review the proposed rules and wish to share your feedback with us, please email Sarah.Johanek@policycentermmh.org or drop your thoughts below.

The Policy Center is grateful for the commitment of The Biden Administration to improving accessibility to mental health and SUD care and looks forward to supporting the Administration in shaping and implementing the final rules.