The Biden administration is set to implement major new regulations requiring insurers to provide mental health and addiction care on the same terms as other medical services. This move follows concerns that insurers have violated a 2008 law designed to ensure mental health parity.
Officials have stated that the new rules will address evasions by insurers that have led many people to pay out-of-pocket for care despite having insurance. They also plan to introduce potential fines for those who do not comply. However, these changes are expected to face legal challenges from the insurance industry.
Neera Tanden, head of President Joe Biden’s Domestic Policy Council, emphasized that the new rules aim to prevent people from depleting their savings or going into debt for mental health care. “No one should have to drain their savings or go into debt to get help for themselves or their loved ones,” Tanden said. “President Biden and Vice President Harris believe mental health is health.”
The regulations are anticipated to affect millions of Americans, especially as the nation confronts a worsening mental health crisis. Many individuals with substance use disorders and mental health conditions do not receive the treatment they need.
Some aspects of the regulations will take effect next year, while other parts will be implemented when insurance plans renew in 2026. This new policy also gives Vice President Kamala Harris a significant issue to highlight during her campaign, as expanding access to mental health care is widely supported.
Though the full details of the regulations have not been released, they are expected to align closely with the proposals put forth by the White House last year. The rules will prevent insurers from using restrictive tools such as prior authorization and stringent out-of-network payment standards for mental health care. They will also require insurers to address significant gaps in access to mental health and substance use disorder treatment.
A 2022 report to Congress from the Departments of Health and Human Services (HHS), Labor, and Treasury revealed that none of the 156 insurance plans studied were compliant with the 2008 law’s requirements.
Tanden has indicated that while the administration prefers a collaborative approach to enforcement, it is prepared to fully enforce the parity law. The insurance industry, however, is likely to push back, arguing that the regulations unfairly target them.
The American Health Insurance Plans (AHIP) group has cited workforce shortages as a key factor in the barriers to care. The Blue Cross Blue Shield Association has warned that the new regulations could lead to unintended consequences, such as compromising patient safety by forcing plans to accept lower-quality providers. BCBSA has called for a broader strategy to address workforce issues and licensing concerns.
There are concerns that employers might reduce mental health coverage in response to the expanded regulations and potential costs. Additionally, the regulations could face legal challenges, particularly in light of the Supreme Court’s recent decision to overturn the Chevron doctrine, which previously supported federal agencies’ regulatory interpretations.
Despite potential legal hurdles, senior administration officials remain confident that the new regulations are consistent with existing laws.
