How The White House will cut red tape in the mental health and substance use disorder insurance industry?

The Biden administration announced a final rule designed to increase access and lower costs for mental and substance use disorder treatment. Most provisions of the rule will apply to group health plans and health insurance issuers for plans beginning on or after Jan. 1.

The rule requires that mental health and substance use disorder services in private insurance plans be covered at the same level as physical health services. This could mean "bringing more mental health and substance use professionals into the network or reducing bureaucratic delays in providing care."

"Mental health care is health care. But for too many Americans, critical care and treatment is out of reach. Today, my Administration is taking action to address our nation's mental health crisis by ensuring that mental health coverage is at the same level as other health care for Americans. There is no reason for a broken arm to be treated any differently than a mental illness," President Joe Biden said in a statement.

The rule reinforces the Mental Health Parity and Addiction Equity Act, known as MHPAEA, a 2008 federal law that requires insurance plans that cover mental health to do so at the same level as physical health. Despite that law, insurers have often made it difficult for people to access in-network mental health care, White House domestic policy adviser Neera Tanden said at the briefing. Instead, people continue to incur high mental health care costs, often having to seek out-of-network care and pay out of pocket.

The rule requires insurers to evaluate coverage based on several criteria, including provider networks, how much they pay for out-of-network coverage, and how often prior authorization is required and approved under existing plans, the administration said.

"No one will have to spend their savings or go into debt to get help for themselves or their loved ones," Tanden said, adding that this change could help the 175 million people with private insurance access care through their own plans.

The final rule will also close a loophole that exempted federal health plans from complying with MHPAEA - the administration estimates it will require more than 200 additional health plans to improve mental health care for 120,000 consumers.

Tanden emphasized that access to mental health care "is critical to the well-being of our families."

"As you all know, mental health issues affect every corner of the country. Approximately two out of five American adults suffer from anxiety or depression. Tragically, suicide is the second leading cause of death among young people ages 10 to 24," Tanden said, calling the numbers "unacceptable."

The administration said the ministries of Labor, Finance and Health and Human Services will oversee compliance with the rules.

"For too long, workers have faced unnecessary barriers to accessing treatment for mental and substance use disorders - barriers that can mean the difference between life and death. The Biden-Harris administration is committed to tearing down these walls and ensuring that every worker has equal access to the treatment they need to thrive physically and mentally," Acting Labor Secretary Julie Su said in a statement.

However, the law does not require employers to offer mental health benefits to employees. The ERISA Industry Committee, a large employer group known as ERIC, said some of the proposed changes are "so onerous that many of our members will have no choice but to reconsider the type and level of coverage in their plans."

Melissa Bartlett, ERIC's senior vice president of health policy, said Monday that the final rule takes into account some stakeholder feedback but "adds complexity" for employers offering behavioral health benefits.

"As ERIC evaluates this rule and the implications for member companies, we will consider all options to prevent further harm to employers offering behavioral health benefits and the employees and families who rely on them, up to and including litigation," Bartlett said.

In a joint statement, the Association for Behavioral Health and Wellness, Blue Cross and Shield Association and ERIC said the rule will have "unintended consequences" that could drive up costs and jeopardize access to mental health care. Addressing the shortage of mental health providers is a top priority, the groups said, but "the final rule will make compliance so difficult that it will be impossible to enforce, leading to worsening patient conditions."

Biden administration officials said the final rule gives insurers clarity on their obligations, and the departments will help plans bring them into compliance. They noted that some provisions will not apply until January 2026.

"Health care, whether for physical or behavioral health conditions, is health care. No one should receive less service for one thing or another," U.S. Health and Human Services Secretary Xavier Becerra said in a statement. "This is the law. The regulations we are issuing today make that clear."