Biden admin reveals rules to help employers comply with mental health, substance abuse coverage laws

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Mental health, substance abuse coverage overview:

• Who: Three federal agencies have proposed rules aimed at ensuring employer health plans comply with federal mental health and substance abuse coverage laws.
• Why: The agencies are responding to a mental health and substance abuse crisis that has worsened during the COVID-19 pandemic.
• Where: The federal rule would apply nationwide.

Three federal agencies have proposed rules aimed at ensuring employer health plans comply with mental health and substance abuse coverage laws, Law360 reports.

The U.S. Department of Labor, the U.S. Department of the Treasury, and the U.S. Department of Health and Human Services released the proposed mental health coverage rules on July 25,

The agencies also released a report to Congress regarding changes to federal mental health parity laws established in 2020, including new requirements for health care plans to assess their restrictions to behavioral health plans.

“This rule will stop the industry evasion that has led millions of people to pay for care even when they have insurance, and for those that can’t afford to pay out of pocket, they have just gone without the treatments they need,” said White House Domestic Policy Adviser Neera Tanden.

Proposed substance abuse, mental health coverage law amends 2008 law

The agencies proposed amendments to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which requires employer health plans to provide mental health coverage and substance abuse coverage with similar limitations to those applied for their medical or surgical coverage.

However, the 2008 law allegedly provided inadequate enforcement to ensure insurance companies and health care plans were complying. In 2020, Congress passed a law granting the DOL new enforcement authority and gave a 2021 deadline for health plans and insurance companies to demonstrate that the limitations on mental health and substance abuse coverage are no more restrictive than other coverage through their health care plans.

In the proposed rule, the three agencies note that the COVID-19 pandemic has worsened America’s mental health and substance use disorder crisis. They point to data from the Centers for Disease Control and Prevention that found the percentage of adults exhibiting symptoms of anxiety or depressive disorders increased from 36.4 percent to 41.5 percent between August 2020 and February 2021.

Children and adolescents are also affected by the mental health and substance use disorder crisis, the agencies note. When patients seek treatment for mental health and substance use disorders, they often find that coverage for these treatments is handled differently than treatment for medical and surgical conditions, making it challenging for patients to receive the treatment they need.

Under the proposed rule, group health plans must not impose more restrictive limitations on mental health and substance abuse coverage than they do for medical and surgical treatment.

In its first report to Congress in 2022, every health plan surveyed by the DOL reportedly received a failing grade regarding their compliance with the law.

In 2018, Blue Shield of California agreed to pay $7 million to settle a class action lawsuit alleging it imposed improper restrictions on mental health coverage.

Have you experienced disparities with your insurance plan’s mental health coverage or substance abuse coverage compared with other treatments covered by your plan? Tell us about it in the comments!

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