A federal law designed to improve access to care for mental health and substance use issues has been bolstered by final rules with input from the AAP.
The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) aims to prevent insurers from being more stringent with benefits for mental health or substance use disorder (MH/SUD) treatment than for medical/surgical (M/S) treatment. The Sept. 9 final rules issued by the U.S. Departments of Labor, Treasury and Health and Human Services (HHS) include new requirements that reinforce that purpose and close loopholes.
“As pediatricians continue to face challenges with helping their patients address mental health concerns, the final rules of MHPAEA will help to reduce some of the barriers to our patients,” said AAP Immediate Past President Sandy L. Chung, M.D., FAAP.
In a 2023 letter to federal officials, Dr. Chung outlined some of those barriers, including insurance delays or denials that cause children to miss appointment slots; nonquantitative treatment limitations (NQTL) like stepwise therapy and prior authorization requirements that can hold up critical prescriptions; insurers’ overreliance on a diagnosis to cover care; and billing restrictions that keep patients from seeking MH/SUD care and M/S care on the same day.
“(C)hildren are not little adults; they require services and care specifically suited to their unique developmental needs,” Dr. Chung wrote. “The system must be prepared to address their unique needs across the continuum of mental health care services.”
In a statement on the changes to MHPAEA, the Biden administration said the final rules:
- require insurers to evaluate how much they pay out-of-network providers and how often they ask for/deny prior authorizations, and make changes if the analysis finds it is harder for individuals to access mental health and substance use benefits than medical benefits;
- clarify that insurers cannot use more restrictive prior authorization techniques or narrower networks for MH/SUD care; and
- close a loophole that kept more than 200 non-federal governmental health plans from complying with the act.
The changes also prohibit insurers from using biased or non-objective information that might negatively affect access to MH/SUD care when applying NQTLs, according to a news release from HHS.
“Simply put, getting care for anxiety should be as easy as getting medical help for an injured shoulder, and getting medication to treat depression should be as simple as getting medication to treat high cholesterol,” said Lisa M. Gomez, assistant secretary for employee benefits security.
According to HHS, most of the changes to MHPAEA will take effect for insurers starting on the first day of the first plan year beginning on or after Jan. 1, 2025. Some will take another year to implement.
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