On Sept. 9, the Biden administration finalized rules aimed at expanding mental health parity measures under the Mental Health Parity and Addiction Equity Act (MHPAEA). Since its enactment in 2008, MHPAEA has required that health insurers provide equal coverage for mental health and substance use disorder (MH/SUD) services as they do for medical and surgical (M/S) services. Yet, significant barriers to behavioral health services remain, particularly due to policies like Non-Quantitative Treatment Limitations (NQTLs), including prior authorization requirements and inadequate provider networks.
This newly finalized rule, closely aligned with NBCC’s recommendations in our 2023 comments, seeks to address these barriers. Below are the key provisions in the final rule and what they mean for counselors and patients alike.
- Beginning Jan. 1, 2026, MHPAEA’s provisions will apply to large employer health plans governed by the Employee Retirement Income Security Act (ERISA), broadening the reach of parity protections and ensuring more Americans have access to comprehensive behavioral health care.
- In line with NBCC’s recommendations, the final rule includes coverage for autism, eating disorders, and dementia under MHPAEA protections. Starting at the next plan year, groups must comply, and individual health plans must comply by Jan. 1, 2026.
- The rule leans more heavily into data and reporting requirements for health plans than the original proposed rule. Health plans are required to submit action plans aimed at resolving discrepancies found between MH/SUD and M/S services. Compliance is required by the beginning of the plan year starting on or after Jan. 1, 2026.
- To ensure MH/SUD services are as robust as M/S services, health plans must offer at least one “core treatment” for each covered MH/SUD service. The final rule also requires health insurers to base coverage decisions on independent and unbiased medical standards. These provisions, also supported by NBCC, will apply to individual and group plans starting in the plan year beginning on or after Jan. 1, 2026.
- Plans must regularly assess the adequacy and accuracy of their provider networks, subjecting them to third-party reviews when appropriate. However, the final rule does not automatically deem NQTLs out of compliance when significant access discrepancies are found, which was included in the proposed rule.
- Providers, acting as authorized representatives for patients with denied claims, can request written documentation of a health plan’s or insurer’s compliance with MHPAEA, beginning on Jan. 1, 2025.
Although this rule is a step forward for mental health parity, it faces opposition. Large employers and insurers argue that these measures could raise premiums and reduce mental health coverage. We expect that legal challenges may delay the rule’s implementation. There’s also a possibility that a future administration may choose to not fully enforce these provisions.
Outside of rulemaking, state and federal lawmakers are considering legislation aimed at reining in health insurers’ use of NQTLs and promoting parity between MH/SUD and M/S services. NBCC supports the Improving Seniors’ Timely Access to Care Act, which would create an electronic prior authorization system for Medicare Advantage plans in order to reduce delays in care. Late last year, the Senate Finance Committee also advanced the Better Mental Health and Lower Costs Act, which requires Medicare Advantage plans to maintain updated and accurate provider directories. There is a chance that both of these proposals will be included in a health care package at the end of the year.
The final rule, barring legal challenges, could lead to positive developments in how MH/SUD services will be covered and delivered. Counselors can expect improvements in access to care for patients, as the rule incentivizes health plans to expand their networks, enhance telemental health options, and comply with stricter adequacy standards. Additionally, with stronger data collection and reporting requirements, there will be more scrutiny on how claims and reimbursements are handled, potentially leading to higher reimbursement rates for counselors. However, it’s important to be aware of possible legal challenges and delays in the rule’s full implementation.
NBCC will continue to monitor these developments and advocate for reforms to NQTLs that will lead to improved access to mental health care for patients. For more details on the finalized rule, and what it means for counselors, check out the fact sheet for providers from the Departments of Labor, Health and Human Services, and the Treasury.
