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Expert Praises Proposed Federal Rule to Strengthen Behavioral Health Parity

Analysis  |  By Christopher Cheney  
   August 01, 2023

The new proposed federal rule from the Biden administration builds on the Mental Health Parity and Addiction Equity Act.

A new proposal from the Biden administration to strengthen parity for behavioral health services with physical health services is a step in the right direction, according to Carl Marci, MD, a psychiatrist at Massachusetts General Hospital and an assistant professor of psychiatry at Harvard Medical School.

Research indicates that access to mental health services is more difficult to obtain than access to physical health services. For example, one study found that Americans with commercial insurance are more than twice as likely to have to go out of network to get mental health services than to get physical health services.

Since 2008, the federal Mental Health Parity and Addiction Equity Act (MHPAEA) has sought to make it easier for people to obtain treatment for mental health and substance use disorders by requiring health plans that cover these conditions to do so on par with other health needs.

The Biden administration proposal includes three elements to build on the requirements of MHPAEA:

  • Health plans should make changes when they are providing inadequate access to mental health services. Health plans should evaluate the outcomes of their coverage rules to ensure that people have equal access to mental health services and physical health services.
  • "The proposed rule will provide specific examples that make clear that health plans cannot use more restrictive prior authorization, other medical management techniques, or narrower networks that make it harder for people to access mental health and substance use disorder benefits than their medical benefits," a statement from the White House says.
  • The proposed rule would close a loophole in MHPAEA that does not require non-federal government health plans such as those offered to state employees to comply with the law.

"President Biden's proposed rule is critically important. A lot of people are suffering—only half of adults with mental health issues get access to care, and it is worse for children and people with substance abuse issues," Marci told HealthLeaders.

The proposed federal rule will likely shine light on how many people seek behavioral health services out of network, he says. "It is a great idea to have more transparency and accountability for insurance companies. Making regulators aware of the percentage of patients who are using out-of-network providers for mental health services versus physical health services is an important indicator."

Tackling onerous prior authorization for behavioral health services is essential, Marci says. "Another good element of the proposed rule is to minimize prior authorization, which requires clinicians to justify providing mental health services to insurance companies. An example that I use is if you have a large cut on your arm and you go into an emergency room, the physician does not stop half-way through the visit and call the insurance company to see whether care can be provided. In mental health, we routinely have to justify care part way through treatment. Reducing that kind of friction in providing care is important."

There are three reasons why there should be behavioral health parity with physical health coverage, he says.

"No. 1, in the medical field, we are morally and ethically obligated to treat people who are suffering. No. 2, it is a false distinction between physical health and mental health. They are two sides of the same coin. There are plenty of examples such as people who have chronic pain and depression, and when their chronic pain is addressed, their depression improves. The reverse of that happens frequently—if you have patients who are chronically depressed and have diabetes or high cholesterol, it is hard to get those people to exercise or eat well, which makes their physical health worse. Third is the economic issue. We know that any physical illness when combined with depression is harder to treat and will cost more to treat."

More needs to be done to establish coverage parity between behavioral health services and physical health services. Marci says.

"The status of behavioral health parity is poor, which is why the Biden administration is taking action and directing several agencies in the federal government to try to enforce rules and laws that have been on the books for years. We have a situation where there are not enough providers—psychiatrists, nurse practitioners, physician assistants, social workers, and therapists—to satisfy the need for care. The reimbursement rates for treatment are not high enough to incentivize mental health providers to go in-network and take patients. We need to do a better job at attracting more professionals to the field of behavioral health."

Related: Providers and Payers React to New Mental Health Parity Report Deficiencies

Christopher Cheney is the CMO editor at HealthLeaders.


Elements of the proposed federal rule include banning prior authorization for behavioral health services that is more restrictive than prior authorization for physical health services.

The proposed federal rule would also likely require health plans to report how many people seek behavioral health services out of network.

Increasing reimbursement rates for behavioral health services is needed to attract more professionals to the field.

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