White House Announces New Rules Requiring Insurance Companies to *Actually* Cover Mental Health Care
“There is no reason that breaking your arm should be treated differently than having a mental-health condition,” President Biden said in an official White House statement released September 9.
- Christen Linke Young, JD, deputy director of the Domestic Policy Council for Health and Veterans
- Jared L. Skillings, PhD, ABPP, psychologist and American Psychological Association chief of professional practice
This, of course, isn’t a new sentiment, which is why we currently have the bipartisan Mental Health Parity and Addiction Equity Act (MHPAEA), a federal law that works to prevent insurance companies from discriminating against mental-health conditions and substance-use disorders. While it was passed by congress in 2008 and “strengthened” in 2020, according to the White House, it hasn’t been very effective at creating equality between physical and mental health.
The current state of health care
The White House cites a study that shows people are four times more likely to go out of network for mental health care than they are for physical health care, demonstrating that whatever insurance companies are offering is just not cutting it. Jared L. Skillings, PhD, chief of professional practice at the American Psychological Association, agrees with the sentiment, citing a study to Well+Good showing that patients of psychologists go out of network ten times more frequently than patients of specialty physicians.
The goal of the new rules from the White House is to get insurance companies to follow the law and treat mental-health coverage on par with how they currently treat physical-health coverage—specifically, making sure there's equity in both "quantitative" types of coverage and "qualitative" types of coverage (stay with us).
Quantitative coverage
Quantitative coverage refers to types of coverage that are relatively easy to assess and compare. For example, is your annual deductible for your mental health care the same as the deductible for your physical health care? If you see a psychiatrist, will insurance cover the same percentage of that visit that they would for a medical doctor?
Christen Linke Young, the deputy director of the White House's Domestic Policy Council for Health and Veterans, says the MHPAEA "was pretty effective in its original drafting," particularly in "getting rid of quantitative limits on mental health." Translation: The MHPAEA effectively created equity in these apples-to-apples situations, so, for example, your annual deductible for behavioral health would have to be the same as your annual deductible for physical health. Easy comparison, easy answer.
Qualitative coverage
But there are many cases where it's murkier to compare mental and physical treatments, notes Young, and these apples-to-oranges cases are called "qualitative" coverage. For example, if you see a therapist that isn't an MD (which the majority of talk-therapists fall under), should your appointment get covered the same way as a doctor's appointment?
Another example: If a person survives a traumatic accident and is prescribed daily therapy as part of their trauma treatment, should it be covered at the same level as a surgery? Compounding the issue: Are there even trauma therapists in-network who are also taking on new clients? If not, and you need to go out of network and pay out of pocket, how quickly does insurance reimburse you?
Knowing how to handle these apples-to-oranges cases is the aim of the new rules from the White House. According to Young, the rules are meant to "set up a mandatory structure" for insurers to not only follow, but to also evaluate—and fix—any issues within qualitative-coverage areas that "are a little bit harder to measure."
What this really means
To address these qualitative-care issues, insurers will now be required to submit to audits and reviews to the Department of Labor to ensure parity between mental and physical health care. It bars insurers from using “medical management techniques” (like pre-authorization requirements and limited provider networks) that can make it harder for people to get care, if providers aren't requiring those same requirements or offering similarly narrow networks for physical health care.
And while the the MHPAEA (and these new rules) apply to private health insurers and federal insurance plans, part of the new rules includes expanding the reach of the MHPAEA to non-federal government-provided insurance plans, like plans for state workers. If you’re yassing along to all of this, we’re with you. As President Biden said in the statement, “mental health care is health care,” and insurance companies had better get on board—though it unfortunately won't happen over night).
When will we see changes?
Most of the provisions in the new set of rules will go into effect for plans beginning in January 2025, and the rules in their entirety will be the law of the land in 2026. However, there's a chance you might be able to get easier access to insurance-covered mental health care sooner. For provider networks, Young says the writing has been on the wall for some time that insurance companies need to do better, so they have been expanding those networks in the lead up to the rules.
"It's not a switch that's going to flip, where yesterday there were a hundred providers in the network, and on January 1, there's going to be 300," Young says. Still, "in-network care should be incrementally easier to find every day now that we have finalized the rule."
So, if you've been putting off finding a therapist because the last time you checked there were no in-network providers who were taking on new clients, or if you thought a specialized treatment like EMDR was out of reach because insurance wouldn't cover it, or even if you haven't been submitting therapy bills for reimbursement because the process was too slow or onerous, you might want to explore your options again starting in the new year.
Another immediate impact: If insurance is denying coverage, Young says the new rules arm individuals with a stronger tool to get them to cover their treatment. "The new rule will help to hold insurance companies accountable," says Dr. Skillings.
It's good news—with some caveats
Getting insurers to cover mental health care is just one piece of the puzzle. Providers also need to choose to accept insurance or be in-network with insurers. And for providers to be incentivized to do that, insurance companies will need to make it financially worth their while. Because as long as the price of mental health care stays astronomically high (with costs averaging between $175 to $650 per 45-minute session in areas like New York City), it will continually be in the best interest of a provider to be paid directly out of pocket by their clients, rather than get reimbursed by insurance at a lower rate.
"Many psychologists have told us that they stopped participating with insurance due to low pay and cumbersome administrative burdens like prepayment reviews, frequent audits, and claw backs of payments already made," Dr. Skillings tells Well+Good. "Many psychologists are ready and willing to work with insurance companies provided that they are treated fairly."
Young says that's an aim of the rules.
"You can expect to see higher payment rates that may make it more attractive for providers to come in-network," Young says, meaning therapists should be getting paid more for insurance-covered visits. "You can also expect to see insurers investing in networks for providers other than physicians," Young says. That means insurance might cover more mental health providers than they did before, such as non-MD therapists, social workers, or telehealth services.
Of course, the federal government can establish rules, but insurers still have to follow them. The rules state that if the Department of Labor, which regulates health insurance, finds that an insurer hasn't done the necessary audits, or hasn't made changes, the agency can compel them to cover certain treatments. However, it does not state how it will do that— whether that's by levying fines, or by some other punishment. There's also the question of whether or not the federal government is even the correct legislator or enforcer here. According to the Kaiser Family Foundation, states have traditionally played the biggest role in regulating health insurers.
Can these new rules get insurers to actually stand behind the idea that “mental health care is health care”? Dr. Skillings is "optimistic that the new rule will bring meaningful change." But it's also too soon to tell.
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