Biden administration announces new rule aimed at ensuring parity in mental health care coverage

President Joe Biden on Tuesday will announce new action to guarantee access to mental health care, unveiling a proposed rule that would ensure mental health benefits on private insurance plans more closely mirror physical health benefits.

The proposed rule would reinforce 2008’s Mental Health Parity and Addiction Equity Act (MHPAEA) by requiring insurance providers to update health plans “to make sure people have equivalent access between their mental health and medical benefits,” according to an administration fact sheet shared with CNN ahead of Tuesday’s announcement,

“For the many families out there who are paying out of pocket to pay for the care their loved ones need, even when they have health insurance, help is on the way,” White House Domestic Policy Adviser Neera Tanden told reporters on a Monday call previewing the announcement. “This rule will make sure that we have true parity, and 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.”

The rule would call on insurers to evaluate coverage based on a number of benchmarks, including the plan’s provider network, how much plans pay for out-of-network coverage and how often prior authorization is required and approved under existing plans, according to the administration.

“These analyses will show plans where they are failing to meet their requirements under the law, and will require plans to improve access to mental health care – by including more mental health professionals in their networks or reducing red tape to get care – to be in compliance with the law,” the fact sheet states.

Enforcement of the rule will fall to the departments of Labor, Treasury and Health and Human Services, an administration official said.

“One of the major things this rule is doing is making it much easier to enforce when health plans are violating the standards of the rule,” the official told reporters ahead of the announcement. “It is making extremely clear what health plans need to do to be in compliance with the requirements of mental health parity so that regulators, whether the Department of Labor, or state insurance commissioners, or whomever, have the ability to take those enforcement actions, and really hold people to the standards of the rule.”

Addressing mental health – and the disparities between mental and physical health care – were part of Biden’s proposed “unity agenda,” which he unveiled during his 2022 State of the Union address. At the time, he called on Congress to join him, saying: “And let’s get all Americans the mental health services they need. More people they can turn to for help, and full parity between physical and mental health care.”

The proposed rule would close a loophole that exempted federally provided health insurance plans from complying with the MHPAEA, a move that the administration estimates would require more than 200 additional health plans to improve mental health care for 90,000 consumers.

Once the rule is published in the Federal Register, which officials expect will occur sometime next week, it enters a 60-day public comment period before it can take effect.