Navigating the Biden-Harris Administration’s Final Rule
Mental Health Parity Compliance for MCOs
The Biden-Harris Administration’s final rule on mental health parity compliance represents a significant advancement in improving access to mental health and substance disorder services for 175 million Americans by making coverage on par with physical health care coverage.
Background on Mental Health Parity
The Mental Health Parity and Addiction Equity Act (MHPAEA), enacted in 2008, established a federal law that requires health plans to provide mental health and substance use disorder benefits on par with medical and surgical benefits. Despite this Act, a 2020 report revealed that significant gaps in access to mental health care and substance abuse services remained for many children and adults.
What changes with the final rule for MCOs?
The final rule, enacted on September 9, 2024, reinforces MHPAEA’s core mission by enhancing beneficiary protections and ensuring equal access to mental health and substance use benefits.
Coverage Parity: Health plans will need to provide mental health and substance use disorder benefits at the same level as medical benefits.
Network Adequacy: Health plans will need to evaluate their provider networks to ensure adequate access to mental health and substance use care professionals.
Prior Authorization: The rule prohibits health plans from using more restrictive prior authorization or other medical management techniques for mental health and substance use disorder benefits compared to medical benefits.
Payment Rates: Health plans must use similar factors in setting out-of-network payment rates for mental health and substance use disorder providers as they do for medical providers.
To the Future
Health plans are required to conduct evaluations to ensure they are not making it harder for individuals to access mental health and substance use benefits than medical benefits, such as how often they require and deny prior authorizations for mental health services. Health plans will need to make changes according to the evaluation outcomes to come into compliance.
The final Biden-Harris Administration's rule will go into effect starting January 1, 2025, for group health plans entering a new plan year and January 1, 2026, for individual health plans. The Department of Health and Human Services will support this important initiative by releasing new tools for states to ensure compliance with MJPAEA’s protections for Medicaid beneficiaries.
Aligning with Agilian’s mission to support health equity for beneficiaries, we are dedicated to supporting MCOs through this transition to ensure mental health parity is not just a goal but a reality.