Biden Administration Issues Groundbreaking Final Rule on Behavioral and Physical Health Parity
Biden Administration Issues Groundbreaking Final Rule on Behavioral and Physical Health Parity
Ensure Equal Treatment for Mental and Physical Health Services Under Federal Health Plan
As of September 9th, a major victory for mental health parity was achieved. Health plans will now be required to apply the same pre-authorization and other nonquantitative limitations to behavioral health as they do to physical health.
The Breakdown:
The Biden administration has introduced a new rule that updates mental health parity compliance, ensuring that behavioral health benefits are treated on par with physical health benefits. This rule strengthens oversight on how health plans handle nonquantitative treatment limitations (NQTLs), such as:
Prior authorization requirements, for both types of care.
Frequency of medical record requests
Pre-certification timeline penalties
Additional Details
This new rule expands upon the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA), which aimed to eliminate disparities in coverage between mental health, addiction services, and physical health care.
Starting in 2025 (for group plans) and 2026 (for individual plans):
Health plans must collect and compare data on NQTLs' impact on access to care.
Plans must address disparities between behavioral and physical health services.
Comparative analyses must be shared with federal agencies.
Advocates believe the rule will reduce barriers to accessing behavioral healthcare.
Critics in the insurance industry argue the rule is vague and burdensome.
The rule pushes for equitable access to behavioral healthcare, though reimbursement disparities and out-of-network care issues remain.
As this is a developing story, please refer to regular updates from these resources: