Payers Oppose Biden’s Mental Health Parity Proposal

The Biden administration’s proposed behavioral health parity rules received a wave of criticism this week from payer associations and House workforce chairs.

Mental health parity, which requires health plans to cover behavioral health at the same level as physical health care, has been law for more than a decade. However, federal agencies have lacked the capacity to enforce these regulations.

Over the summer, the U.S. Department of Labor issued a proposed rule requiring health plans to evaluate coverage criteria and non-quantitative treatment limit (NQTL) requirements. The Departments of Health and Human Services and the U.S. Treasury will also have important roles in developing and implementing the rule.

Shortly after the proposed rule was released, provider groups, including the American Medical Association, the American Hospital Association and the National Behavioral Health Care Association, came out in support.

Some payer groups and lawmakers are now questioning the new proposal and fear it could increase bureaucracy.

The Committee is strongly concerned that the Tri-Agency proposed rules would only weaken parity compliance by giving prominence to bureaucratic reporting, paperwork, and audits, Rep. Virginia Foxx (R-NC), chair of the House workforce committee, said in a report. letter sent to agencies related to the proposal. This will divert funding, time and resources from helping patients struggling with mental health and substance use disorders (MH/SUD) and will divert valuable resources to meaningless paperwork requests.

Meanwhile, the ERISA Industry Commission (ERIC) warns that the proposed regulation could have the opposite effect on parity.

Specifically, the organization said federal law does not require employers to provide health benefits to their employees. However, if they provide mental health benefits, all parity requirements apply.

The proposed regulations are so burdensome that many of our members will have no choice but to rethink the type and level of coverage of their plans. [mental health and substance use disorder] benefits,” ERIC wrote in a letter. To be clear, such a significant change in coverage is not because our members want to impose changes to their existing coverage. However, the significant burdens associated with the proposed regulations would increase administrative costs, taking away valuable and finite resources to provide additional coverage and care.

ERIC is an industry group that represents large employers that provide health, retirement and compensation benefits to their employees.

Payers also expressed concerns about testing certain treatments and providing effective care. The BlueCross Blue Shield Association (BCBSA) has noted that these requirements could lead to an increase in care that is not clinically recommended.

David Merritt, BCBSA senior vice president of policy and advocacy, said in a statement: “This rule could push us in the wrong direction by forcing health plans to eliminate protections.” important to ensure patients receive safe, medically necessary and effective care. We will continue to work with our partners, the administration and Congress to improve both access and quality for Americans.

The Blue Cross Blue Shield Association is an association of 34 independent and community-based Blue Cross Blue Shield companies.

Despite opposition from payers, providers and provider organizations overwhelmingly support the new regulations.

When behavioral health treatment is delayed or denied, the results can be tragic, and for too long, insurance companies have created inappropriate barriers to care through Unnecessary administrative burdens include prior authorizations, inadequate networks, lack of benefits, and other denials or delays in necessary care, said Dr. Jesse Ehrenfeld, president of the Association American Medicine, said in a statement. The AMA continues to call on the administration to take action to remove barriers to evidence-based mental health and substance use disorder care in all health insurance programs.