President Biden and Vice President Harris announce historic final rule that will ensure mental health care coverage for 175 million Americans is on par with their physical health care coverage

President Biden and Vice President Harris believe that health care is a right, not a privilege, and that mental health care is health care – period. But for millions of Americans, care for mental health and substance use conditions is still hard to find and hard to afford. Today, the Biden-Harris Administration is taking a step toward changing that, by placing new requirements on health plans that will improve and strengthen access to mental health care for 175 million Americans with private health insurance.

Statement from the President: “Mental health care is health care. But for far too many Americans, critical care and treatments are out of reach. Today, my Administration is taking action to address our nation’s mental health crisis by ensuring mental health coverage will be covered at the same level as other health care for Americans. There is no reason that breaking your arm should be treated differently than having a mental health condition. The steps my Administration is taking today will dramatically expand access to mental health care in America.”

Statement from the Vice President: “President Biden and I are committed to ensuring that every person in our country has the mental health care they need to thrive. That is why we made the largest investment in youth mental health in history and are transforming how mental health is understood, perceived, and treated for all Americans. Today, we are building on this lifesaving and lifechanging work by announcing the finalization of a historic rule that will expand mental health care across our nation so more of our loved ones, neighbors, coworkers, and classmates receive the care they deserve. As someone who has spent my entire career fighting to improve the health and well-being of all Americans, I will never stop working to ensure that health care is a right – not just a privilege for those who can afford it.”

For over 15 years, robust access to mental health care has been a bipartisan priority. Thanks to the 2008 enactment of the Mental Health Parity and Addiction Equity Act (MHPAEA), which was further strengthened in 2020 on a bipartisan basis, health plans that cover mental health and substance use care benefits must do so at the same level as physical health care benefits. But despite this landmark law, too many Americans still struggle to find and afford the care they need. In 2020, less than half of all adults with mental illness received treatment. For children, the numbers are even worse: nearly 70 percent of our kids who seek care for mental health or substance use cannot get it. That’s in part because insurers too often make it difficult to access mental health treatment, causing millions of consumers to have high out-of-pocket costs because they go out-of-network, or defer care altogether. One study shows that insured people are nearly four times as likely go out-of-network and pay higher fees for mental health care than for physical health care. And the problem is getting worse: in recent years, the gap between usage of out-of-network care for mental health and substance use disorder benefits versus physical health benefits increased 85 percent.

Today’s final rule strengthens consumer protections by reinforcing MHPAEA’s fundamental purpose that all Americans should have the same access to mental health and substance use benefits as they do physical health benefits. And it will help lower families’ health care costs by making it easier to access mental health and substance use care and getting rid of barriers that keep people from getting the care they need, when they need it, for a price they can afford. Specifically, the final rule will:

Require health plans to make changes when they are providing inadequate access to mental health and substance use care. In 2020, Congress made changes to MHPAEA that require health plans to conduct meaningful comparative analyses to make sure that they are not making it harder for individuals to access mental health and substance use benefits than it is to access medical benefits. Today’s new requirements make it clear that health plans need to evaluate their provider networks, how much they pay out-of-network providers, and how often they require – and deny – prior authorizations. The outcomes of these evaluations will show plans where they are failing to meet the law’s requirements, and where they will need to make changes to come into compliance, like adding more mental health and substance use professionals to their networks or reducing red tape for providers to deliver care.
Make it clear what health plans can and cannot do. Health plans cannot use more restrictive prior authorization, or other medical management techniques, or narrower networks to make it harder for people to access mental health and substance use disorder benefits than their medical benefits. Health plans also have to use similar factors in setting out-of-network payment rates for mental health and substance use disorder providers as they do for medical providers.
Close existing loopholes. When MHPAEA was first enacted, it did not require non-federal governmental health plans, like those offered to state and local government employees, to comply with its requirements. Today’s final rule closes that loophole, and now requires more than 200 additional health plans to comply with MHPAEA, providing critical protections to 120,000 consumers.

Thanks to the Biden-Harris Administration, these new requirements will help more people get the mental health and substance use care they need while also making sure that mental health and substance use care professionals are paid fairly, likely incentivizing more people to join the mental health workforce. In addition to today’s final rule, the Department of Health and Human Services is also releasing new tools for states to ensure compliance with MHPAEA’s critical protections for the millions of Medicaid beneficiaries enrolled in private Medicaid health plans.

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